Provider Demographics
NPI:1730130469
Name:AMDEMARIAM, SOLOMON YEBIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:YEBIO
Last Name:AMDEMARIAM
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 1:5901 W BEHREND DR
Mailing Address - Street 2:#1056
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6943
Mailing Address - Country:US
Mailing Address - Phone:623-594-7866
Mailing Address - Fax:623-594-7866
Practice Address - Street 1:20280 N 59TH AVE
Practice Address - Street 2:STE 115 PMB 544
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6850
Practice Address - Country:US
Practice Address - Phone:623-293-8480
Practice Address - Fax:623-594-7866
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856114Medicaid
AZH57002Medicare UPIN
AZ856114Medicaid