Provider Demographics
NPI:1992207815
Name:HAILE, AMANUEL BERHANE (RT)
Entity Type:Individual
Prefix:
First Name:AMANUEL
Middle Name:BERHANE
Last Name:HAILE
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRANBY WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9166
Mailing Address - Country:US
Mailing Address - Phone:720-339-1029
Mailing Address - Fax:
Practice Address - Street 1:130 GRANBY WAY UNIT C
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9166
Practice Address - Country:US
Practice Address - Phone:720-339-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4985612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology