Healthcare Provider Details

I. General information

NPI: 1154187698
Provider Name (Legal Business Name): NEBIYU MEKBIB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5142 LIVERPOOL WAY
DENVER CO
80249-8545
US

IV. Provider business mailing address

5142 LIVERPOOL WAY
DENVER CO
80249-8545
US

V. Phone/Fax

Practice location:
  • Phone: 720-220-3000
  • Fax:
Mailing address:
  • Phone: 720-220-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number9000207019
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: