# MULUMEBET HAILESELASSIE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912991928
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 036-053422 | IL | — |
| 207V00000X | Obstetrics & Gynecology Physician | 27414 | IA | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0080200 | — | IA |
| 01 | — | 070573 | HEALTH ALLIANCE \# | — |
| 01 | — | 1234295 | CONTROLLED SUBSTANCE\# | IA |
| 01 | — | 291468 | IOWA BC/BS | IA |
| 01 | — | 421060724 | BILLING TAX ID\# FOR CHC | IA |
| 05 | — | 421060724002 | — | IL |
| 01 | — | 42106072428 | JOHN DEERE HEALTH | IA |
| 01 | — | 8122859 | ILLINOIS BC/BS | IL |
| 01 | — | IA0128 | JOHN DEERE EDI\# | IA |