Provider Demographics
NPI:1639150121
Name:HAILE, ZEWDU (MD)
Entity Type:Individual
Prefix:
First Name:ZEWDU
Middle Name:
Last Name:HAILE
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 1:135 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3860
Mailing Address - Country:US
Mailing Address - Phone:630-856-8900
Mailing Address - Fax:
Practice Address - Street 1:135 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3860
Practice Address - Country:US
Practice Address - Phone:630-856-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091812207Q00000X
IL036-091812207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL821050OtherMEDICARE GROUP PTAN
ILG19218Medicare UPIN