Provider Demographics
NPI:1821059841
Name:ABREHA, AMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANUEL
Middle Name:
Last Name:ABREHA
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 1:723 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-4813
Mailing Address - Country:US
Mailing Address - Phone:832-331-8438
Mailing Address - Fax:936-336-2862
Practice Address - Street 1:723 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4813
Practice Address - Country:US
Practice Address - Phone:832-331-8438
Practice Address - Fax:936-336-2862
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI31772Medicare UPIN