Provider Demographics
NPI:1114714334
Name:GOSHE, MULUSEW TIBEBU (MD)
Entity type:Individual
Prefix:
First Name:MULUSEW
Middle Name:TIBEBU
Last Name:GOSHE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 ELMSIDE VILLAGE LN APT E
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4876
Mailing Address - Country:US
Mailing Address - Phone:619-560-7276
Mailing Address - Fax:
Practice Address - Street 1:917 PACIFIC AVE STE 600
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4437
Practice Address - Country:US
Practice Address - Phone:253-844-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty