Provider Demographics
NPI:1831676147
Name:TIKUE, ALAY GEBREMEDHIN (MD)
Entity Type:Individual
Prefix:
First Name:ALAY
Middle Name:GEBREMEDHIN
Last Name:TIKUE
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 1:3601 4TH ST # MS 9410
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:800-674-3179
Mailing Address - Fax:806-743-3143
Practice Address - Street 1:3601 4TH ST # MS 9410
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:800-674-3179
Practice Address - Fax:806-743-3143
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program