Healthcare Provider Details

I. General information

NPI: 1215344791
Provider Name (Legal Business Name): TESHOME GEBRMICHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DAWSON ST
TYLER TX
75701-2036
US

IV. Provider business mailing address

800 E DAWSON ST
TYLER TX
75701-2036
US

V. Phone/Fax

Practice location:
  • Phone: 903-531-5784
  • Fax: 954-776-8532
Mailing address:
  • Phone: 903-531-5784
  • Fax: 954-776-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4225
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR4225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: