Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 44627 | AZ |
NPI | 1023222619 |
---|---|
Provider Name | Legesse Mekonnen |
First Address | Phoenix, AZ 85037-3328 |
Second Address | Phoenix, AZ 85037-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 28/12/2011 |