Provider Demographics
NPI:1013009729
Name:KABTIMER, HAILU T (MD)
Entity Type:Individual
Prefix:
First Name:HAILU
Middle Name:T
Last Name:KABTIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 W MAIN ST M3
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-826-2102
Mailing Address - Fax:615-826-2743
Practice Address - Street 1:919 W MAIN ST M3
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-826-2102
Practice Address - Fax:615-826-2743
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3843759Medicaid
TN3843759Medicaid
G99453Medicare UPIN