Provider Demographics
NPI:1083497622
Name:MULUNEH, TIRUSEW
Entity Type:Individual
Prefix:
First Name:TIRUSEW
Middle Name:
Last Name:MULUNEH
Suffix:
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 1:2172 S TRENTON WAY APT 5-205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5384
Mailing Address - Country:US
Mailing Address - Phone:720-278-9165
Mailing Address - Fax:
Practice Address - Street 1:2172 S TRENTON WAY APT 5-205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5384
Practice Address - Country:US
Practice Address - Phone:720-278-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101020947343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)