Provider Demographics
NPI:1619904992
Name:ASSEFA, GIRMA BALCHA (MD)
Entity Type:Individual
Prefix:
First Name:GIRMA
Middle Name:BALCHA
Last Name:ASSEFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W 22ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1225
Mailing Address - Country:US
Mailing Address - Phone:630-320-1160
Mailing Address - Fax:
Practice Address - Street 1:100 W 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2003
Practice Address - Country:US
Practice Address - Phone:708-730-2200
Practice Address - Fax:708-210-0636
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-078388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF23361Medicare UPIN