Provider Demographics
NPI:1073819595
Name:SISAY, EMNET (MD)
Entity Type:Individual
Prefix:
First Name:EMNET
Middle Name:
Last Name:SISAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMNET
Other - Middle Name:SISAY
Other - Last Name:WORKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 802772
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-2772
Mailing Address - Country:US
Mailing Address - Phone:972-484-7700
Mailing Address - Fax:972-484-7718
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:STE. 325
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2158
Practice Address - Country:US
Practice Address - Phone:817-887-9389
Practice Address - Fax:817-887-9392
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3106207RI0200X, 207RI0200X
390200000X
NY262786207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program