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NPI Code Detail

MEDICARE: MULUMEBET HAILESELASSIE M.D.

MEDICARE: MULUMEBET HAILESELASSIE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician27414IA
2207V00000XObstetrics & Gynecology Physician036-053422IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38122859OTHERILILLINOIS BC/BS
4291468OTHERIAIOWA BC/BS
542106072428OTHERIAJOHN DEERE HEALTH
6070573OTHERHEALTH ALLIANCE #
71234295OTHERIACONTROLLED SUBSTANCE#
8IA0128OTHERIAJOHN DEERE EDI#
9421060724OTHERIABILLING TAX ID# FOR CHC

General Provider Information

NPI Number : 1912991928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MULUMEBET HAILESELASSIE M.D.
Provider Business Mailing Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3125
Provider Business Practice Location Address
First Line : 500 W RIVER DR
Second Line :
City : DAVENPORT
State : IA
Zip : 52801-1014
Country : US
Telephone Number : 563-336-3000
Fax Number : 563-336-3125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 03/07/2023

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