Provider Demographics
NPI:1336369438
Name:HAILE, ADDISU
Entity type:Individual
Prefix:MR
First Name:ADDISU
Middle Name:
Last Name:HAILE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ADDISU
Other - Middle Name:
Other - Last Name:HAILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2564 DEXTER STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207
Mailing Address - Country:US
Mailing Address - Phone:303-355-5341
Mailing Address - Fax:
Practice Address - Street 1:1733 VINE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-504-1000
Practice Address - Fax:303-394-9820
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator