Provider Demographics
NPI:1952718744
Name:HAILU, TEKLEAB ELOS (TRANSPORTATION PROVI)
Entity Type:Individual
Prefix:
First Name:TEKLEAB
Middle Name:ELOS
Last Name:HAILU
Suffix:
Gender:M
Credentials:TRANSPORTATION PROVI
Other - Prefix:
Other - First Name:TEKLEAB
Other - Middle Name:ELOS
Other - Last Name:HAILU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4810 FLANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7528
Mailing Address - Country:US
Mailing Address - Phone:720-278-1330
Mailing Address - Fax:
Practice Address - Street 1:4810 FLANDERS WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7528
Practice Address - Country:US
Practice Address - Phone:720-278-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO900 LQJ347C00000X
CO285 MCT347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle