Provider Demographics
NPI:1407344922
Name:BEKELE, EZANA NEGUSSU
Entity type:Individual
Prefix:DR
First Name:EZANA
Middle Name:NEGUSSU
Last Name:BEKELE
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 1:1717 WEST MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3609
Mailing Address - Country:US
Mailing Address - Phone:220-564-2950
Mailing Address - Fax:220-564-2951
Practice Address - Street 1:1717 WEST MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3609
Practice Address - Country:US
Practice Address - Phone:220-564-2950
Practice Address - Fax:220-564-2951
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.151653207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology