Individual
TATEK KETEMA TAKELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
8901 W LINCOLN AVE, WEST ALLIS, WI 53227-2409
(414) 328-6000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 328-6600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036119404
IL
207R00000X
Internal Medicine Physician
MD60877192
WA
208M00000X
Hospitalist Physician
Primary
52806-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003313
—
WI
Enumeration date
11/09/2007
Last updated
12/19/2023
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