Provider Demographics
NPI:1164417986
Name:BARTOLOMEI, EDDIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:BARTOLOMEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDDIE
Other - Middle Name:
Other - Last Name:BARTOLOMEI VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11687 VICOLO LOOP
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6054
Mailing Address - Country:US
Mailing Address - Phone:407-497-6623
Mailing Address - Fax:248-926-0176
Practice Address - Street 1:11687 VICOLO LOOP
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6054
Practice Address - Country:US
Practice Address - Phone:407-497-6623
Practice Address - Fax:248-926-0176
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2014-02-19
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
MI4301064370208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103439403Medicaid
E31338Medicare UPIN
MI103439403Medicaid