Provider Demographics
NPI:1003414988
Name:BIREGA, ADDISU ALEMU I
Entity Type:Individual
Prefix:
First Name:ADDISU
Middle Name:ALEMU
Last Name:BIREGA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DAYTON ST APT 3-203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1330
Mailing Address - Country:US
Mailing Address - Phone:720-240-7420
Mailing Address - Fax:
Practice Address - Street 1:600 S DAYTON ST APT 3-203
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1330
Practice Address - Country:US
Practice Address - Phone:720-240-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170848260172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver