Individual ProviderBirukti Gebreyohannes HabtezgiStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address945 N 12th St, Milwaukee, WI 53233-1305(414) 219-7136PECOS EnrollmentBased on the most recent information from CMS, provider Birukti Gebreyohannes Habtezgi does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1073369492Provider TypeIndividualFull NameHabtezgi, Birukti GebreyohannesCredentialMDGenderFemaleSole ProprietorNoEnumeration Date4/26/2024Last Updated6/23/2024Contact InformationPractice LocationPractice Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-7136Fax(414) 219-6264Mailing LocationMailing Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-7136Fax(414) 219-6264Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense100751-851Wisconsin