Provider Demographics
NPI:1457849333
Name:ASSEFA, MICHAEL SOLOMON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SOLOMON
Last Name:ASSEFA
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 1:303 PARKWAY DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1212
Mailing Address - Country:US
Mailing Address - Phone:404-265-6415
Mailing Address - Fax:404-265-6488
Practice Address - Street 1:350 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2602
Practice Address - Country:US
Practice Address - Phone:520-296-3211
Practice Address - Fax:520-873-3211
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1912-320208M00000X
GA87671208M00000X
TN66318208M00000X
390200000X
AZ72362208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100210088Medicaid