Individual
EJEGAYEHU TEREFE-GIFAWOSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3500 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 865-8630
(765) 864-5901
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01068519
IN
207R00000X
Internal Medicine Physician
Primary
D0077157
MD
208M00000X
Hospitalist Physician
01068519
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200996560
—
IN
01
—
P00905153
RAILROAD MEDICARE PTAN
IN
01
—
P01270943
RR MEDICARE
IN
Enumeration date
12/03/2007
Last updated
09/25/2025
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