Provider Demographics
NPI:1740923598
Name:GMICHAEL, TESFAYE
Entity type:Individual
Prefix:
First Name:TESFAYE
Middle Name:
Last Name:GMICHAEL
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 1:11128 LIBERTY FARMS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5972
Mailing Address - Country:US
Mailing Address - Phone:512-577-8743
Mailing Address - Fax:
Practice Address - Street 1:11128 LIBERTY FARMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5972
Practice Address - Country:US
Practice Address - Phone:512-577-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)