Provider Demographics
NPI:1750172847
Name:KIDANE, BISRAT
Entity type:Individual
Prefix:
First Name:BISRAT
Middle Name:
Last Name:KIDANE
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 1:6321 N LONDON AVE APT I
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4737
Mailing Address - Country:US
Mailing Address - Phone:202-817-1977
Mailing Address - Fax:
Practice Address - Street 1:6321 N LONDON AVE APT I
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-4737
Practice Address - Country:US
Practice Address - Phone:202-817-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)