Provider Demographics
NPI:1447604772
Name:KURFESSA, KEDIR J
Entity Type:Individual
Prefix:
First Name:KEDIR
Middle Name:J
Last Name:KURFESSA
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 1:1821 UNIVERSITY AVE W STE S336
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2876
Mailing Address - Country:US
Mailing Address - Phone:651-434-2087
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S336
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2876
Practice Address - Country:US
Practice Address - Phone:651-434-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN815TEP343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)