Healthcare Provider Details

I. General information

NPI: 1992098719
Provider Name (Legal Business Name): EYOEL T ABEBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 AVON LN
FRISCO TX
75033-1301
US

IV. Provider business mailing address

190 E STACY RD STE 306
ALLEN TX
75002-8738
US

V. Phone/Fax

Practice location:
  • Phone: 903-990-0001
  • Fax:
Mailing address:
  • Phone: 903-990-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ5611
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301099441
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ5611
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301099441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: