Provider Demographics
NPI:1366593360
Name:HABTE-GABR, EYASSU (MD)
Entity type:Individual
Prefix:DR
First Name:EYASSU
Middle Name:
Last Name:HABTE-GABR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1085 S LINDEN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3421
Mailing Address - Country:US
Mailing Address - Phone:810-732-3240
Mailing Address - Fax:810-230-0280
Practice Address - Street 1:TWO HURLEY PLAZA
Practice Address - Street 2:SUITE 109
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:810-762-5354
Practice Address - Fax:810-762-7243
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051570207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1830320Medicaid
MA1830320Medicaid