Provider Demographics
NPI:1518662022
Name:MEKONNEN, DAWIT YIFRU
Entity Type:Individual
Prefix:
First Name:DAWIT
Middle Name:YIFRU
Last Name:MEKONNEN
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 1:23531 E ALABAMA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-3026
Mailing Address - Country:US
Mailing Address - Phone:720-278-0774
Mailing Address - Fax:
Practice Address - Street 1:23531 E ALABAMA DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-3026
Practice Address - Country:US
Practice Address - Phone:720-278-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172A00000X
172A00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver