Provider Demographics
NPI:1770825861
Name:GEBRETSADIK, SEFANIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SEFANIT
Middle Name:
Last Name:GEBRETSADIK
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 1:190 E STACY RD STE 306139
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8734
Mailing Address - Country:US
Mailing Address - Phone:404-939-3752
Mailing Address - Fax:
Practice Address - Street 1:4645 AVON LN STE 215
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1614
Practice Address - Country:US
Practice Address - Phone:903-990-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69596208M00000X
TXS8560207R00000X
MI4301503221207R00000X
OH35.140750207R00000X
IDM-15420207R00000X
GA069596207R00000X
OK37365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist