Provider Demographics
NPI:1356708754
Name:TEKLEGORIGS, AMELMAL SHIBRU (050590252)
Entity type:Individual
Prefix:MS
First Name:AMELMAL
Middle Name:SHIBRU
Last Name:TEKLEGORIGS
Suffix:
Gender:F
Credentials:050590252
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 TRENTON ST DENVER CO 80220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:720-327-3255
Mailing Address - Fax:303-360-7707
Practice Address - Street 1:14821 E KANSAS PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:720-327-3255
Practice Address - Fax:303-360-7707
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)