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General NPI Number Information
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NPI Number | 1164999660
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Entity Type | Individual
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Provider Name | TADESSE KEBEDE DEBELE MD, MS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 4900 W CRAIG RD
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City | LAS VEGAS
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State | NV
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Zip | 89130-2737
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Country | US
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Telephone | 252-693-3687
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Fax | 725-293-5350
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Provider Business Mailing Address
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Address Line | 102 WOODMONT BLVD STE 600
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City | NASHVILLE
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State | TN
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Zip | 37205-5250
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R7887
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2058
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R78887
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26094
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License Number State | NV
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