Basic Information
| Provider Information | |||||||||
| NPI: | 1992191050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASCHENAKI | ||||||||
| FirstName: | BETHEAL | ||||||||
| MiddleName: | GEBREHIWOT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3911 VINEYARD DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770822844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323107566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1227 E RUSHOLME ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634213122 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD-45866 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | OH | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.