Individual
FITSUM WOLDESELLASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 TOWNE LAKE PKWY STE 308, WOODSTOCK, GA 30189-1604
(414) 805-3310
Mailing address
900 TOWNE LAKE PKWY STE 308, WOODSTOCK, GA 30189-1604
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
100672
GA
207RG0100X
Gastroenterology Physician
8176020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194257279
—
WI
Enumeration date
03/29/2017
Last updated
06/27/2024
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