Individual
FIKADU GEBREYES TEKLEYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1320 W MAIN ST, NEWARK, OH 43055
(220) 564-7750
(220) 564-7751
Mailing address
1320 W MAIN ST, NEWARK, OH 43055
(220) 564-7750
(220) 564-7751
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35.129008
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2797997
—
OH
05
—
3810010703
—
WV
01
—
613154600
BLACK LUNG/FECA
WV
05
—
7100038120
—
KY
01
—
P00836670
RR MEDICARE
WV
Enumeration date
05/10/2007
Last updated
03/19/2021
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