Provider Demographics
NPI:1437729308
Name:KIDANE, MILLA
Entity Type:Individual
Prefix:
First Name:MILLA
Middle Name:
Last Name:KIDANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 CIMMARON TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2520
Mailing Address - Country:US
Mailing Address - Phone:469-443-2979
Mailing Address - Fax:
Practice Address - Street 1:10330 CIMMARON TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2520
Practice Address - Country:US
Practice Address - Phone:469-443-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347E00000X, 343900000X
TX343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
No343800000XTransportation ServicesSecured Medical Transport (VAN)