Healthcare Provider Details

I. General information

NPI: 1972855138
Provider Name (Legal Business Name): RHEUMETOLOGY ARTHRITIS IMMUNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 E PLAZA EAST BLVD
EVANSVILLE IN
47715-2861
US

IV. Provider business mailing address

5015 E PLAZA EAST BLVD
EVANSVILLE IN
47715-2861
US

V. Phone/Fax

Practice location:
  • Phone: 812-437-2340
  • Fax: 812-491-1972
Mailing address:
  • Phone: 812-437-2340
  • Fax: 812-491-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01053981A
License Number StateIN

VIII. Authorized Official

Name: MOGES SISAY
Title or Position: OWNER
Credential: MD
Phone: 812-437-2340