Provider Demographics
NPI:1033669445
Name:T-BEYENE HYPERTENSION & KIDNEY CARE PLC
Entity Type:Organization
Organization Name:T-BEYENE HYPERTENSION & KIDNEY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TADESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-209-3378
Mailing Address - Street 1:4572 RANCH LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2440
Mailing Address - Country:US
Mailing Address - Phone:773-209-3378
Mailing Address - Fax:248-595-8269
Practice Address - Street 1:4160 JOHN R STE 1011
Practice Address - Street 2:HARPER PROFESSIONAL BUILDING
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-341-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092774207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821239302Medicaid
MI1821239302Medicaid