Healthcare Provider Details

I. General information

NPI: 1225346885
Provider Name (Legal Business Name): KINFE GEBEYEHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CLINTON AVE
OAK PARK IL
60304-1825
US

IV. Provider business mailing address

1125 CLINTON AVE
OAK PARK IL
60304-1825
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-8141
  • Fax: 708-383-9140
Mailing address:
  • Phone: 708-383-8141
  • Fax: 708-383-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: