Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | ME139890 | FL |
NPI | 1235472572 |
---|---|
Provider Name | Karezhe Tigineh Mersha |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103465400 | (05) | FL |