Provider Demographics
NPI:1710574462
Name:AYELE, ENDALKACHEW MENGSTE (MR)
Entity Type:Individual
Prefix:MR
First Name:ENDALKACHEW
Middle Name:MENGSTE
Last Name:AYELE
Suffix:
Gender:M
Credentials:MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10785 E EXPOSITION AVE # C320
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2118
Mailing Address - Country:US
Mailing Address - Phone:720-550-2401
Mailing Address - Fax:
Practice Address - Street 1:10785 E EXPOSITION AVE # C320
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2118
Practice Address - Country:US
Practice Address - Phone:720-550-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163370364343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)