Provider Demographics
NPI:1710916705
Name:ALEMU, ENGIDA B (MD)
Entity Type:Individual
Prefix:
First Name:ENGIDA
Middle Name:B
Last Name:ALEMU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 W 24TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-314-3201
Mailing Address - Fax:928-314-3202
Practice Address - Street 1:2281 W 24TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-314-3201
Practice Address - Fax:928-314-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274858Medicaid
AZ274858Medicaid