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General NPI Number Information
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NPI Number | 1518531623
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Entity Type | Individual
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Provider Name | GETACHEW GENETU TEGEGNE MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 821 ULRICH AVE
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City | LOUISVILLE
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State | KY
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Zip | 40219-1844
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Country | US
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Telephone | 317-515-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 5876 MARCO CT
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City | PLAINFIELD
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State | IN
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Zip | 46168-7534
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Country | US
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Telephone | 317-515-9622
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0-672-338-1
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License Number State | ZZ
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