=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326677196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HIWOT AYALEW GOBEZIE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2020
-----------------------------------------------------
Last Update Date | 07/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 E DIVISION ST
-----------------------------------------------------
City | FOND DU LAC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54935-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-926-8420
-----------------------------------------------------
Fax | 920-926-8913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4507 MADISON ST
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20737-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-593-2290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 82406-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------