Provider Demographics
NPI:1376117788
Name:ZEWDIE, KALEAB AZALE
Entity Type:Individual
Prefix:
First Name:KALEAB
Middle Name:AZALE
Last Name:ZEWDIE
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 1:13115 WHITTINGTON DR APT 1101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2679
Mailing Address - Country:US
Mailing Address - Phone:832-904-2479
Mailing Address - Fax:
Practice Address - Street 1:13115 WHITTINGTON DR APT 1101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-2679
Practice Address - Country:US
Practice Address - Phone:832-904-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)