Healthcare Provider Details

I. General information

NPI: 1316398043
Provider Name (Legal Business Name): KIRUBEL GEBRESENBET DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 BROADWAY BLVD STE 212
GARLAND TX
75041-3794
US

IV. Provider business mailing address

2080 GLENCOE DR
ROCKWALL TX
75087-2400
US

V. Phone/Fax

Practice location:
  • Phone: 619-342-6199
  • Fax:
Mailing address:
  • Phone: 972-435-6096
  • Fax: 972-521-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: