Healthcare Provider Details

I. General information

NPI: 1316123383
Provider Name (Legal Business Name): ABNET AMSALEWORK ALEMU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 06/03/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 COUNTRY HILLS DRIVE
ANTIOCH CA
94506
US

IV. Provider business mailing address

2350 COUNTRY HILLS DRIVE
ANTIOCH CA
94506
US

V. Phone/Fax

Practice location:
  • Phone: 612-508-2755
  • Fax:
Mailing address:
  • Phone: 612-508-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA115475
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA115475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: