Provider Demographics
NPI:1528305372
Name:ZETAWOS, MEKLIT (PA)
Entity type:Individual
Prefix:
First Name:MEKLIT
Middle Name:
Last Name:ZETAWOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 N HILLSIDE ST
Mailing Address - Street 2:STE. 410
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4923
Mailing Address - Country:US
Mailing Address - Phone:316-686-5300
Mailing Address - Fax:316-651-2660
Practice Address - Street 1:551 N HILLSIDE ST
Practice Address - Street 2:STE. 410
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-686-5300
Practice Address - Fax:316-651-2660
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMA1899282OtherDEA