1033669445 NPI number — T-BEYENE HYPERTENSION & KIDNEY CARE PLC

Table of content: (NPI 1033669445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033669445 NPI number — T-BEYENE HYPERTENSION & KIDNEY CARE PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T-BEYENE HYPERTENSION & KIDNEY CARE PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033669445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4572 RANCH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-209-3378
Provider Business Mailing Address Fax Number:
248-595-8269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 JOHN R STE 1011
Provider Second Line Business Practice Location Address:
HARPER PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-341-1431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BEYENE
Authorized Official First Name:
TADESSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-209-3378

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  4301092774 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821239302 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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