Provider Demographics
NPI:1568062990
Name:MELAKI, ESAYAS
Entity Type:Individual
Prefix:
First Name:ESAYAS
Middle Name:
Last Name:MELAKI
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 1:6236 HORTON CIR APT 36A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3765
Mailing Address - Country:US
Mailing Address - Phone:972-215-8609
Mailing Address - Fax:
Practice Address - Street 1:6236 HORTON CIR APT 36A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3765
Practice Address - Country:US
Practice Address - Phone:972-215-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver