Individual
DR. WIHIB AMBAYE GEBREGEORGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4160 JOHN R, SUITE 917, HARPER PROFESSIONAL BUILDING, DETROIT, MI 48201-2020
(313) 745-4525
(313) 745-0011
Mailing address
1420 STEPHENSON HWY, SUITE 400 - CREDENTAILING, TROY, MI 48083-1189
(248) 581-5972
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301087251
MI
207RN0300X
Nephrology Physician
Primary
4301087251
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-0251457-2
BCBSM INDIVIDUAL PIN
MI
05
—
1366632713
—
MI
01
—
OB56031
BCBSM IM GROUP
MI
Enumeration date
07/31/2007
Last updated
02/19/2014
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