Provider Demographics
NPI:1679787386
Name:TEKLEYES, FIKADU GEBREYES (MD)
Entity type:Individual
Prefix:
First Name:FIKADU
Middle Name:GEBREYES
Last Name:TEKLEYES
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 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-7750
Mailing Address - Fax:220-564-7751
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-7750
Practice Address - Fax:220-564-7751
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129008207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100038120Medicaid
WV3810010703Medicaid
OH2797997Medicaid
WV613154600OtherBLACK LUNG/FECA
WVP00836670OtherRR MEDICARE
WV3810010703Medicaid
KY7100038120Medicaid