Provider Demographics
NPI:1700659612
Name:GEBREYESUS, TATEK
Entity Type:Individual
Prefix:MR
First Name:TATEK
Middle Name:
Last Name:GEBREYESUS
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 1:5954 S HELENA ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1036
Mailing Address - Country:US
Mailing Address - Phone:732-491-3008
Mailing Address - Fax:
Practice Address - Street 1:5954 S HELENA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1036
Practice Address - Country:US
Practice Address - Phone:732-491-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)