Healthcare Provider Details

I. General information

NPI: 1184664401
Provider Name (Legal Business Name): KIFLE ADMASSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DENVER TRL
AZLE TX
76020-3614
US

IV. Provider business mailing address

305 HAWKS RIDGE TRL
COLLEYVILLE TX
76034
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-960-6648
  • Fax: 817-960-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM1448
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number91426
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: