Provider Demographics
NPI:1982471231
Name:GEBRELUL, TEKLIT
Entity Type:Individual
Prefix:
First Name:TEKLIT
Middle Name:
Last Name:GEBRELUL
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 1:8620 PARK LN APT 1018
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-6886
Mailing Address - Country:US
Mailing Address - Phone:214-862-8253
Mailing Address - Fax:
Practice Address - Street 1:8620 PARK LN APT 1018
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6886
Practice Address - Country:US
Practice Address - Phone:214-862-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45213061343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)