Healthcare Provider Details

I. General information

NPI: 1336050277
Provider Name (Legal Business Name): MICHAEL BETEMARIAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

IV. Provider business mailing address

1128 FOWLER DR
GREENVILLE NC
27834-3335
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 704-605-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number70182803
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: