Individual
DR. ELIAS NIGUSSIE WOLDEGABRIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
611 W PARK ST, INFECTIOUS DISEASE, URBANA, IL 61801-2529
(217) 383-1554
(217) 383-1523
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6941
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
0101254167
VA
207RI0200X
Infectious Disease Physician
Primary
036140939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316252265
—
VA
Enumeration date
08/16/2010
Last updated
09/30/2016
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