Basic Information
| Provider Information | |||||||||
| NPI: | 1366593360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HABTE-GABR | ||||||||
| FirstName: | EYASSU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1085 S LINDEN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107323240 | ||||||||
| FaxNumber: | 8102300280 | ||||||||
| Practice Location | |||||||||
| Address1: | TWO HURLEY PLAZA | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107625354 | ||||||||
| FaxNumber: | 8107627243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 4301051570 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 1830320 | 05 | MA | MEDICAID |