Provider Demographics
NPI:1619781952
Name:NESIBU, NATENAEL KEBEDE (DO)
Entity type:Individual
Prefix:
First Name:NATENAEL
Middle Name:KEBEDE
Last Name:NESIBU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:NATI
Other - Middle Name:
Other - Last Name:NESIBU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3778 KINVIEW ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 MICHIGAN ST NE FL 9
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2531
Practice Address - Country:US
Practice Address - Phone:616-391-3777
Practice Address - Fax:616-391-3755
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5151017318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program