Provider Demographics
NPI:1154187698
Name:MEKBIB, NEBIYU
Entity type:Individual
Prefix:
First Name:NEBIYU
Middle Name:
Last Name:MEKBIB
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 1:5142 LIVERPOOL WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8545
Mailing Address - Country:US
Mailing Address - Phone:720-220-3000
Mailing Address - Fax:
Practice Address - Street 1:5142 LIVERPOOL WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8545
Practice Address - Country:US
Practice Address - Phone:720-220-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9000207019172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver