Provider Demographics
NPI:1063027928
Name:TESFAMICHAEL, ABRAHAM F
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:F
Last Name:TESFAMICHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 107TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2070
Mailing Address - Country:US
Mailing Address - Phone:206-420-9838
Mailing Address - Fax:
Practice Address - Street 1:1700 SW 107TH ST APT 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2070
Practice Address - Country:US
Practice Address - Phone:206-420-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA4131171R00000X
WAMA4022171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter