Provider Demographics
NPI:1427289339
Name:METIKU, TESFAMARIAM OKBAY (MD)
Entity type:Individual
Prefix:DR
First Name:TESFAMARIAM
Middle Name:OKBAY
Last Name:METIKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19928 EDINBERG DR
Mailing Address - Street 2:DEPT OF MEDICAL EDUCATION
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21409 KELLY RD STE 400
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3264
Practice Address - Country:US
Practice Address - Phone:586-777-0630
Practice Address - Fax:586-777-0631
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine