Provider Demographics
NPI:1083705461
Name:TEKOLA, ABRHAM (MD)
Entity type:Individual
Prefix:
First Name:ABRHAM
Middle Name:
Last Name:TEKOLA
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 1:5740 WINDMILL WAY
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1379
Mailing Address - Country:US
Mailing Address - Phone:916-480-0506
Mailing Address - Fax:916-480-0609
Practice Address - Street 1:5740 WINDMILL WAY
Practice Address - Street 2:SUITE # 5
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-480-0506
Practice Address - Fax:916-480-0609
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A509740Medicaid
CA00A509740Medicaid
F38631Medicare UPIN