Basic Information
| Provider Information | |||||||||
| NPI: | 1639176829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANMIGUEL | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KENANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283498801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102962774 | ||||||||
| FaxNumber: | 9102962771 | ||||||||
| Practice Location | |||||||||
| Address1: | 4402 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104521400 | ||||||||
| FaxNumber: | 9103321072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9900341 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1191T | 01 | NC | BCBS | OTHER | Q00345 | 05 | SC | MEDICAID | 891191T | 05 | NC | MEDICAID | 01-28699 | 01 | NC | UNITED HEALTHCARE | OTHER | 930077044 | 01 | NC | RAILROAD MEDICARE | OTHER | B4557 | 01 | NC | MEDCOST | OTHER | 930084657 | 01 | RAILROAD MEDICARE | OTHER |