Provider Demographics
NPI:1285454561
Name:ABRAHA, GHEBREKIDAN KIBROM
Entity type:Individual
Prefix:
First Name:GHEBREKIDAN
Middle Name:KIBROM
Last Name:ABRAHA
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 1:9923 E JEWELL AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6221
Mailing Address - Country:US
Mailing Address - Phone:720-229-9289
Mailing Address - Fax:
Practice Address - Street 1:9923 E JEWELL AVE APT 202
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-6221
Practice Address - Country:US
Practice Address - Phone:720-229-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20248082430343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)