Provider Demographics
NPI:1851089601
Name:HAILU, MILKIAS
Entity Type:Individual
Prefix:
First Name:MILKIAS
Middle Name:
Last Name:HAILU
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 1:25827 W DUNLAP RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9149
Mailing Address - Country:US
Mailing Address - Phone:720-585-5678
Mailing Address - Fax:
Practice Address - Street 1:25827 W DUNLAP RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9149
Practice Address - Country:US
Practice Address - Phone:720-585-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor