Healthcare Provider Details

I. General information

NPI: 1104186287
Provider Name (Legal Business Name): LULSEGED ZENEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST HOSPITAL SERVICE
APPLETON WI
54915-1305
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2000
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56825-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: