Provider Demographics
NPI:1366632713
Name:GEBREGEORGIS, WIHIB AMBAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:WIHIB
Middle Name:AMBAYE
Last Name:GEBREGEORGIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400 - CREDENTAILING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5972
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4160 JOHN R, SUITE 917
Practice Address - Street 2:HARPER PROFESSIONAL BUILDING
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2014-02-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301087251207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366632713Medicaid
MI11-0251457-2OtherBCBSM INDIVIDUAL PIN
MIOB56031OtherBCBSM IM GROUP
MIB56031106Medicare PIN
MIOB56031OtherBCBSM IM GROUP
MI0P30630871Medicare PIN