Provider Demographics
NPI:1689687410
Name:MENGESHA, YEBABE MELAK (MD)
Entity Type:Individual
Prefix:DR
First Name:YEBABE
Middle Name:MELAK
Last Name:MENGESHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20401 N 73RD ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4107
Mailing Address - Country:US
Mailing Address - Phone:480-556-0446
Mailing Address - Fax:480-556-0447
Practice Address - Street 1:19646 N 27TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4017
Practice Address - Country:US
Practice Address - Phone:480-556-0446
Practice Address - Fax:480-556-0447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32769207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137317Medicaid
AZZ128332Medicare PIN
AZ137317Medicaid
AZZ128332Medicare PIN