Healthcare Provider Details

I. General information

NPI: 1629449467
Provider Name (Legal Business Name): ABEBE TEKLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

317 LESTER AVE APT 405
OAKLAND CA
94606-1316
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6813
  • Fax:
Mailing address:
  • Phone: 651-246-3258
  • Fax: 916-734-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number168211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: