Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301110841 | MI |
N | 208000000X | Pediatrician | A144270 | CA |
N | 208000000X | Pediatrician | M-1987 | GU |
NPI | 1003256421 |
---|---|
Provider Name | Dr. Samuel Abebe |
First Address | Ypsilanti, MI 48197-6645 |
Second Address | Ypsilanti, MI 48197-6645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2013 |
Last Update Date | 14/09/2016 |