Healthcare Provider Details

I. General information

NPI: 1881885044
Provider Name (Legal Business Name): GETAHUN ABATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S. GRAND BLVD., DRC-8TH FLOOR
SAINT LOUIS MO
63104-3325
US

IV. Provider business mailing address

1131 INDIAN TRAILS DR
SAINT LOUIS MO
63132-3109
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8000
  • Fax: 314-771-3816
Mailing address:
  • Phone: 314-625-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2007017223
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: