Addisu, Anteneh M

Addisu, Anteneh M is an sole proprietor health care provider with primary practice located at 1600 Sw Archer Rd Box 100277, Gainesville FL 32610-3003. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Addisu, Anteneh M can be contacted via phone (352) 265-0651.

Contact Information

Primary practice address
1600 Sw Archer Rd Box 100277 Gainesville FL 32610-3003
Phone: (352) 265-0651
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X ME75316 Florida

Profile Details

NPI number 1922052471
LBN Legal business name Addisu, Anteneh M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 20th, 2006
Last updated Sep 24th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922052471 NPPES
Florida Other 593534735 TAX ID
Florida MEDICAID 254252800 TAX ID

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