MEDICARE: DR. SOLOMON YEBIO AMDEMARIAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	31855	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730130469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOLOMON YEBIO AMDEMARIAM M.D.

Provider Business Mailing Address
First Line	:	5901 W BEHREND DR
Second Line	:	#1056
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6943
Country	:	US
Telephone Number	:	623-594-7866
Fax Number	:	623-594-7866

Provider Business Practice Location Address
First Line	:	20280 N 59TH AVE
Second Line	:	STE 115 PMB 544
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	623-293-8480
Fax Number	:	623-594-7866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/12/2008

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