Provider Demographics
NPI:1316755333
Name:HAILE, MESFIN
Entity type:Individual
Prefix:
First Name:MESFIN
Middle Name:
Last Name:HAILE
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 1:3153 S URAVAN WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6130
Mailing Address - Country:US
Mailing Address - Phone:602-918-5191
Mailing Address - Fax:
Practice Address - Street 1:3153 S URAVAN WAY APT 105
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6130
Practice Address - Country:US
Practice Address - Phone:602-918-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172165215172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver