Provider Demographics
NPI:1356800478
Name:TILAHUN, NEBIYU ABERA (MD)
Entity type:Individual
Prefix:
First Name:NEBIYU
Middle Name:ABERA
Last Name:TILAHUN
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:AURORA SINAI MEDICAL CENTER, 945 N. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233
Mailing Address - Country:US
Mailing Address - Phone:414-219-7427
Mailing Address - Fax:414-219-6078
Practice Address - Street 1:AURORA SINAI MEDICAL CENTER, 945 N. 12TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-219-7427
Practice Address - Fax:414-219-6078
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75276-20207R00000X
390200000X
WI75276208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100202315Medicaid