Provider Demographics
NPI:1942912803
Name:WELDEMICHAEL, KIBROM S
Entity Type:Individual
Prefix:
First Name:KIBROM
Middle Name:S
Last Name:WELDEMICHAEL
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 1:832 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3212
Mailing Address - Country:US
Mailing Address - Phone:817-965-5605
Mailing Address - Fax:
Practice Address - Street 1:832 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3212
Practice Address - Country:US
Practice Address - Phone:817-965-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)