Provider Demographics
NPI:1417192808
Name:TEKLE, WONDWOSSEN GEBREAMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WONDWOSSEN
Middle Name:GEBREAMANUEL
Last Name:TEKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 HORSESHOE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552
Mailing Address - Country:US
Mailing Address - Phone:571-432-6314
Mailing Address - Fax:
Practice Address - Street 1:2121 PEASE STREET
Practice Address - Street 2:SUITE 1D
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-389-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCTRAINING2084N0400X
TXP72162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325672901Medicaid
TXP7216OtherMEDICAL LICENSE
TX313233YLLZOtherMEDICARE PTAN