Provider Demographics
NPI:1356040638
Name:AREDO, MESFIN MIDEKSSA
Entity type:Individual
Prefix:
First Name:MESFIN
Middle Name:MIDEKSSA
Last Name:AREDO
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 1:16942 PARKSIDE DR S
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-0576
Mailing Address - Country:US
Mailing Address - Phone:720-609-0712
Mailing Address - Fax:303-366-0688
Practice Address - Street 1:10 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6431
Practice Address - Country:US
Practice Address - Phone:720-609-0712
Practice Address - Fax:303-366-0688
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)