Provider Demographics
NPI:1679301568
Name:TIBEBE, ISAAC
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:TIBEBE
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 1:7037 TREEBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1537
Mailing Address - Country:US
Mailing Address - Phone:614-817-4670
Mailing Address - Fax:
Practice Address - Street 1:7037 TREEBOURNE DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1537
Practice Address - Country:US
Practice Address - Phone:614-817-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator