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

Table of Contents

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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