Provider Demographics
NPI:1326231630
Name:ABRHAM TEKOLA M.D. INC
Entity Type:Organization
Organization Name:ABRHAM TEKOLA M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ABRHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-480-0506
Mailing Address - Street 1:5740 WINDMILL WAY
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1379
Mailing Address - Country:US
Mailing Address - Phone:916-480-0506
Mailing Address - Fax:916-480-0609
Practice Address - Street 1:5740 WINDMILL WAY
Practice Address - Street 2:SUITE # 5
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-480-0506
Practice Address - Fax:916-480-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332952261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A509740Medicaid
CAF38631Medicare UPIN