Provider Demographics
NPI:1073556221
Name:BEKELE, MEAZA T (MD)
Entity Type:Individual
Prefix:DR
First Name:MEAZA
Middle Name:T
Last Name:BEKELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N SAN SABA
Mailing Address - Street 2:SUITE 1075
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3154
Mailing Address - Country:US
Mailing Address - Phone:210-223-3543
Mailing Address - Fax:210-227-0282
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:SUITE 1075
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-223-3543
Practice Address - Fax:210-227-0282
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4941208000000X
MDD0061218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219340101Medicaid
MDI20730Medicare UPIN