Provider Demographics
NPI:1669172037
Name:GHEBREMEDHIN, AMANUEL Z
Entity type:Individual
Prefix:MR
First Name:AMANUEL
Middle Name:Z
Last Name:GHEBREMEDHIN
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 1:3646 WISH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3690
Mailing Address - Country:US
Mailing Address - Phone:317-332-2096
Mailing Address - Fax:
Practice Address - Street 1:3646 WISH AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3690
Practice Address - Country:US
Practice Address - Phone:317-332-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver