Provider Demographics
NPI:1245498781
Name:MEKETE, BAHIRU BELACHEW (MD)
Entity type:Individual
Prefix:
First Name:BAHIRU
Middle Name:BELACHEW
Last Name:MEKETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAHIRU
Other - Middle Name:MEKETE
Other - Last Name:BELACHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2220 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2738
Mailing Address - Country:US
Mailing Address - Phone:405-779-2721
Mailing Address - Fax:405-779-2310
Practice Address - Street 1:2220 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2738
Practice Address - Country:US
Practice Address - Phone:405-779-2721
Practice Address - Fax:405-779-2310
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27293208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200257680AMedicaid
OK200257680AMedicaid