Provider Demographics
NPI:1316096522
Name:MITIKU, TEFERI YILMA (MD)
Entity type:Individual
Prefix:DR
First Name:TEFERI
Middle Name:YILMA
Last Name:MITIKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:333 CORPORATE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2113
Mailing Address - Country:US
Mailing Address - Phone:714-456-3868
Mailing Address - Fax:313-745-4399
Practice Address - Street 1:101 CITY DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-3868
Practice Address - Fax:313-745-4399
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA92724207R00000X
MI4301101657207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630813Medicare PIN