Provider Demographics
NPI:1316252265
Name:WOLDEGABRIEL, ELIAS NIGUSSIE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:NIGUSSIE
Last Name:WOLDEGABRIEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:INFECTIOUS DISEASE
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-1554
Practice Address - Fax:217-383-1523
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2016-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101254167207RI0200X
IL036140939207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316252265Medicaid
VA1316252265Medicaid