Woldesellassie, Fitsum
Woldesellassie, Fitsum is an individual health care provider with primary practice located at 900 Towne Lake Pkwy Ste 308 , Woodstock GA 30189-1604. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Woldesellassie, Fitsum can be contacted via phone (414) 805-3310.Contact Information
Primary practice address
900 Towne Lake Pkwy Ste 308
Woodstock GA 30189-1604
Phone: (414) 805-3310
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 100672 | Georgia |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 8176020 | Wisconsin |
Profile Details
| NPI number | 1194257279 |
|---|---|
| LBN Legal business name | Woldesellassie, Fitsum |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 29th, 2017 |
| Last updated | Jun 27th, 2024 - about 5 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194257279 | NPPES |
| Wisconsin | MEDICAID | 1194257279 |
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