| Makonnen G Habtemariam Pllc | |
|
1800 E Van Buren St Phoenix AZ 85006-3742 | |
| (480) 907-7707 | |
| (480) 907-7097 |
| Full Name | Makonnen G Habtemariam Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1800 E Van Buren St, Phoenix, Arizona |
| Authorized Official Name and Position | Makonnen G Habtemariam (SOLE MEMBER) |
| Authorized Official Contact | 4809077707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Makonnen G Habtemariam Pllc Po Box 11773 Chandler AZ 85248-0013 Ph: (480) 907-7707 | Makonnen G Habtemariam Pllc 1800 E Van Buren St Phoenix AZ 85006-3742 Ph: (480) 907-7707 |
| NPI Number | 1043547938 |
|---|---|
| Provider Enumeration Date | 11/12/2009 |
| Last Update Date | 04/24/2015 |
| Medicare PECOS PAC ID | 2264574789 |
|---|---|
| Medicare Enrollment ID | O20100121000839 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043547938 | NPI | - | NPPES |
| 331918 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Makonnen G Habtemariam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851357909 PECOS PAC ID: 1355483876 Enrollment ID: I20100121000838 |
| Provider Name | Manju Krishnamenon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366733560 PECOS PAC ID: 2769650662 Enrollment ID: I20110720000378 |
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