Individual
MR. ELIE TADIESSE DOMGUIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1428 S 88TH ST, WEST ALLIS, WI 53214-4303
(414) 379-1079
Mailing address
1428 S 88TH ST, WEST ALLIS, WI 53214-4303
(414) 379-1079
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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