Basic Information
| Provider Information | |||||||||
| NPI: | 1023182680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEBEDE | ||||||||
| FirstName: | ZELALEM | ||||||||
| MiddleName: | WODAJO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4460 DORAL DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440113744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165092650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24700 LORAIN RD | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407169810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35.083535 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.