Provider Demographics
NPI:1518531623
Name:TEGEGNE, GETACHEW GENETU (MD)
Entity Type:Individual
Prefix:DR
First Name:GETACHEW
Middle Name:GENETU
Last Name:TEGEGNE
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 1:5876 MARCO CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7534
Mailing Address - Country:US
Mailing Address - Phone:317-515-9622
Mailing Address - Fax:
Practice Address - Street 1:821 ULRICH AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1844
Practice Address - Country:US
Practice Address - Phone:317-515-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ0-672-338-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice