Provider Demographics
NPI:1952839615
Name:WOLDETSADIK, MESELE HADDIS
Entity Type:Individual
Prefix:
First Name:MESELE
Middle Name:HADDIS
Last Name:WOLDETSADIK
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 1:428 SHELL CT W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4044
Mailing Address - Country:US
Mailing Address - Phone:614-852-0402
Mailing Address - Fax:
Practice Address - Street 1:428 SHELL CT W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4044
Practice Address - Country:US
Practice Address - Phone:614-852-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health