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General NPI Number Information
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NPI Number | 1447787312
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Entity Type | Individual
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Provider Name | EYOB MELESSE TAFESSU MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 3901 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7738
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Country | US
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Telephone | 972-596-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7738
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125070125
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | S9070
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License Number State | TX
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