Provider Demographics
NPI:1992548564
Name:GEBRESLASSIE, KIFLOM SEYOUM (MD)
Entity type:Individual
Prefix:DR
First Name:KIFLOM
Middle Name:SEYOUM
Last Name:GEBRESLASSIE
Suffix:
Gender:
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:SSM HEALTH SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Mailing Address - Street 2:1402 SOUTH GRAND BLVD, ROOM M260
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-617-2408
Mailing Address - Fax:314-617-2534
Practice Address - Street 1:SSM HEALTH/SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Practice Address - Street 2:1402 SOUTH GRAND BLVD, ST. LOUIS, MO 63104
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-617-2408
Practice Address - Fax:314-617-2534
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-04-29
Deactivation Date:2025-01-17
Deactivation Code:
Reactivation Date:2025-04-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2024028926390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program