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General NPI Number Information
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NPI Number | 1861381444
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Entity Type | Individual
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Provider Name | TSEGAYE WESENSEGED GEBREAMLAK
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 3249 OAK PARK AVE
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City | BERWYN
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State | IL
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Zip | 60402-3429
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Country | US
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Telephone | 708-783-6566
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Fax | 708-783-6567
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Provider Business Mailing Address
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Address Line | 3722 HARLEM AVE
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City | RIVERSIDE
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State | IL
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Zip | 60546-2312
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Country | US
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Telephone | 708-783-6566
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Fax | 708-783-6567
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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 | 125084739
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.084739
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License Number State | IL
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