Healthcare Provider Details

I. General information

NPI: 1770825861
Provider Name (Legal Business Name): SEFANIT GEBRETSADIK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 AVON LN STE 215
FRISCO TX
75033-1614
US

IV. Provider business mailing address

190 E STACY RD STE 306139
ALLEN TX
75002-8734
US

V. Phone/Fax

Practice location:
  • Phone: 903-990-0001
  • Fax:
Mailing address:
  • Phone: 404-939-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number69596
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8560
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301503221
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.140750
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-15420
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number069596
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37365
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: