Provider Demographics
NPI:1922662311
Name:TEKLEMICHAEL, ESTIFANOS ALEM
Entity Type:Individual
Prefix:
First Name:ESTIFANOS
Middle Name:ALEM
Last Name:TEKLEMICHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 S REYNOLDS ST APT 903
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4509
Mailing Address - Country:US
Mailing Address - Phone:301-323-5834
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE # K4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-363-6771
Practice Address - Fax:718-604-5450
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine