Provider Demographics
NPI:1851072060
Name:ABEBE, KITACHEW T
Entity Type:Individual
Prefix:
First Name:KITACHEW
Middle Name:T
Last Name:ABEBE
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 1:4527 N QUATAR CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-3612
Mailing Address - Country:US
Mailing Address - Phone:303-500-9544
Mailing Address - Fax:
Practice Address - Street 1:4527 N QUATAR CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-3612
Practice Address - Country:US
Practice Address - Phone:303-500-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No376J00000XNursing Service Related ProvidersHomemaker