Individual
DR. DEREJE T SIYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-7427
(414) 219-6078
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
74852-20
WI
207RB0002X
Obesity Medicine (Internal Medicine) Physician
74852-20
WI
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
74852-20
WI
2083C0008X
Clinical Informatics Physician
74852-20
WI
208M00000X
Hospitalist Physician
Primary
74852
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100202312
—
WI
Enumeration date
03/19/2019
Last updated
05/17/2026
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