Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 066958 | GA |
Y | 207RN0300X | Nephrologist | 2017038567 | MO |
NPI | 1043405731 |
---|---|
Provider Name | Mr. Tewabe Girima Kebede |
First Address | Kansas City, MO 64132 |
Second Address | Kansas City, MO 64132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-119330 | MEDICAL LICENSE NUMBER (01) | IL |
066958 | MEDICAL LICENCE (01) | GA |
201195680A | (05) | KS |
P1775 | MEDICAL LICENCE (01) | TX |