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General NPI Number Information
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NPI Number | 1316252265
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Entity Type | Individual
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Provider Name | ELIAS NIGUSSIE WOLDEGABRIEL M.D
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Gender | Male
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 611 W PARK ST INFECTIOUS DISEASE
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City | URBANA
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State | IL
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Zip | 61801-2529
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Country | US
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Telephone | 217-383-1554
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Fax | 217-383-1523
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Provider Business Mailing Address
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Address Line | 611 W PARK ST BWPC
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City | URBANA
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State | IL
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Zip | 61801-2529
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Country | US
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Telephone | 217-383-6941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 0101254167
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036140939
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License Number State | IL
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