Provider Demographics
NPI:1982459848
Name:TAYE, KALEMELEKOT NIGUSSIE (MD (CANDIDATE))
Entity Type:Individual
Prefix:
First Name:KALEMELEKOT
Middle Name:NIGUSSIE
Last Name:TAYE
Suffix:
Gender:M
Credentials:MD (CANDIDATE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL, R
Mailing Address - Street 2:GME OFFICE, 3601 W THIRTEEN MILE RD
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-551-3000
Mailing Address - Fax:
Practice Address - Street 1:COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL, R
Practice Address - Street 2:GME OFFICE, 3601 W THIRTEEN MILE RD
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052340390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program