Provider Demographics
NPI:1487347423
Name:BIRHANU, ALAZAR MELESE
Entity type:Individual
Prefix:
First Name:ALAZAR
Middle Name:MELESE
Last Name:BIRHANU
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 1:1201 NORTH HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104
Mailing Address - Country:US
Mailing Address - Phone:160-594-0932
Mailing Address - Fax:
Practice Address - Street 1:1201 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1042
Practice Address - Country:US
Practice Address - Phone:605-940-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1FC786347C00000X
SD01724216347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle