Basic Information
| Provider Information | |||||||||
| NPI: | 1295255289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLDEMARIAM | ||||||||
| FirstName: | RAHEL | ||||||||
| MiddleName: | HAILEMICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 JOSE PADILLA | ||||||||
| Address2: | MODULO 202 B AM ELECTRIC INC | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006801251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047808388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ULYSSES | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678802135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203561261 | ||||||||
| FaxNumber: | 6203563846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 32831 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 04-43491 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.