Makonnen G Habtemariam Pllc | |
1800 E Van Buren St Phoenix AZ 85006-3742 | |
(480) 907-7707 | |
(480) 907-7097 |
Full Name | Makonnen G Habtemariam Pllc |
---|---|
Speciality | Internal Medicine |
Location | 1800 E Van Buren St, Phoenix, Arizona |
Authorized Official Name and Position | Makonnen G Habtemariam (SOLE MEMBER) |
Authorized Official Contact | 4809077707 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Makonnen G Habtemariam Pllc Po Box 11773 Chandler AZ 85248-0013 Ph: (480) 907-7707 | Makonnen G Habtemariam Pllc 1800 E Van Buren St Phoenix AZ 85006-3742 Ph: (480) 907-7707 |
NPI Number | 1043547938 |
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Provider Enumeration Date | 11/12/2009 |
Last Update Date | 04/24/2015 |
Medicare PECOS PAC ID | 2264574789 |
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Medicare Enrollment ID | O20100121000839 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043547938 | NPI | - | NPPES |
331918 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Makonnen G Habtemariam |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1851357909 PECOS PAC ID: 1355483876 Enrollment ID: I20100121000838 |
Provider Name | Manju Krishnamenon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366733560 PECOS PAC ID: 2769650662 Enrollment ID: I20110720000378 |
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