Basic Information
| Provider Information | |||||||||
| NPI: | 1962616631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELAY | ||||||||
| FirstName: | SILESHI | ||||||||
| MiddleName: | ADMASSU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 FRANTZ RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430164141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145668883 | ||||||||
| FaxNumber: | 6145668149 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MCKINLEY PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145668883 | ||||||||
| FaxNumber: | 6145668149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23634 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6883790 | 01 | WV | CIGNA | OTHER | 2952023 | 05 | OH | MEDICAID | 000000276723 | 01 | OH | OH UNISON | OTHER | 3810016385 | 05 | WV | MEDICAID | 7100097220 | 05 | KY | MEDICAID |