Provider Demographics
NPI:1063289106
Name:YITBAREK, BUZAYEHU TEKETEL
Entity type:Individual
Prefix:
First Name:BUZAYEHU
Middle Name:TEKETEL
Last Name:YITBAREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 YAGER CREEK DR APT R
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6330
Mailing Address - Country:US
Mailing Address - Phone:720-592-7559
Mailing Address - Fax:
Practice Address - Street 1:2201 YAGER CREEK DR APT R
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6330
Practice Address - Country:US
Practice Address - Phone:720-592-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)