Healthcare Provider Details

I. General information

NPI: 1891359949
Provider Name (Legal Business Name): EYOB BERIHUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EYOB ALI MD

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

20244 HARBOR TREE RD
MONTGOMERY VILLAGE MD
20886-5821
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-6220
  • Fax: 618-257-6679
Mailing address:
  • Phone: 240-361-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD94705
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036171599
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD94705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: