Elie Tadiesse Domguia

Primary specialty

DriverTaxonomy code 172A00000X

Practice address

1428 S 88TH St
West Allis, WI 53214-4303

Phone

(414) 379-1079

NPI assigned

Mar 27, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1386347474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 S 88TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144303",
            "telephone_number": "414-379-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 S 88TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144303",
            "telephone_number": "414-379-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADIESSE DOMGUIA",
        "first_name": "ELIE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Michelle Syrcle, MD
• Amanda G Szarzynski, PH.D, LMFT
• Michelle Szivecz
• Bethany Anne Tabieros, DPT
• James Arthur Tacyshyn-Roth, DC
• Isaac Olabode Taiwo, MD
• Reina Takamura
• Tatek Ketema Takele, M.D
• Tall Oaks of West Allis
• Jonathan Tallar

• Driver in West Allis, WI
• Providers in West Allis, WI by specialty
• Driver in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.