Provider Demographics
NPI:1134603053
Name:GEBREHIWOT, AMANUEL
Entity type:Individual
Prefix:
First Name:AMANUEL
Middle Name:
Last Name:GEBREHIWOT
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 1:12338 RAINTREE AVE
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8470
Mailing Address - Country:US
Mailing Address - Phone:614-717-8707
Mailing Address - Fax:
Practice Address - Street 1:12338 RAINTREE AVE
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8470
Practice Address - Country:US
Practice Address - Phone:614-717-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver