Provider Demographics
NPI:1467220970
Name:MAKONNEN, MILKYAS TSEHAY
Entity Type:Individual
Prefix:
First Name:MILKYAS
Middle Name:TSEHAY
Last Name:MAKONNEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MILKYAS
Other - Middle Name:TSEHAY
Other - Last Name:MAKONNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2175 ACADEMY CIR STE 8
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1682
Mailing Address - Country:US
Mailing Address - Phone:202-956-9261
Mailing Address - Fax:
Practice Address - Street 1:1799 S DAYTON ST APT 332
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6263
Practice Address - Country:US
Practice Address - Phone:202-956-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver