Individual
MULUMEBET HAILESELASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 336-3125
Mailing address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 336-3125
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036-053422
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
27414
IA
Other
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
Enumeration date
09/06/2005
Last updated
03/07/2023
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