Provider Demographics
NPI:1396910501
Name:TEKLE, TESFAI JULIEN (MD)
Entity type:Individual
Prefix:
First Name:TESFAI
Middle Name:JULIEN
Last Name:TEKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TESFAY
Other - Middle Name:JULIEN
Other - Last Name:TEKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:909 FROSTWOOD DR STE 1.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-6353
Mailing Address - Fax:713-704-3086
Practice Address - Street 1:17500 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2562
Practice Address - Country:US
Practice Address - Phone:281-725-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203526207R00000X
TXS0578207R00000X, 208M00000X
IN01069964A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201045260Medicaid
LA4P731Medicare PIN
INM400055254Medicare PIN
INM400069680Medicare PIN