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General NPI Number Information
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NPI Number | 1114714334
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Entity Type | Individual
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Provider Name | MULUSEW TIBEBU GOSHE MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 917 PACIFIC AVE STE 600
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City | TACOMA
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State | WA
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Zip | 98402-4437
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Country | US
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Telephone | 253-844-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 3748 ELMSIDE VILLAGE LN APT E
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-4876
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Country | US
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Telephone | 619-560-7276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ML70025000
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License Number State | WA
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