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General NPI Number Information
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NPI Number | 1649439050
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Entity Type | Individual
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Provider Name | FREAW NIGUSSIE DEJENIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 3900 ST FRANCIS WAY STE 213
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City | LAFAYETTE
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State | IN
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Zip | 47905-4938
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Country | US
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Telephone | 765-775-2800
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Fax | 765-471-5461
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01073022A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101246521
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D70682
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD038406
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 105556
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD038406
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License Number State | DC
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