Individual
ETSUB NEGUSSIE HAILESELASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1702 ARBOR CREEK DR., GARLAND, TX 75040
(469) 269-7259
Mailing address
1702 ARBOR CREEK DR, GARLAND, TX 75040-8912
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
454534
TX
Other
Enumeration date
08/21/2017
Last updated
04/30/2019
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