Provider Demographics
NPI:1417502121
Name:SUGEBO, MEKETE
Entity Type:Individual
Prefix:
First Name:MEKETE
Middle Name:
Last Name:SUGEBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 EUGENE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-5415
Mailing Address - Country:US
Mailing Address - Phone:720-327-6860
Mailing Address - Fax:720-230-5421
Practice Address - Street 1:4431 EUGENE WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-5415
Practice Address - Country:US
Practice Address - Phone:720-327-6860
Practice Address - Fax:720-230-5421
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health