Organization
KIDANU BIRHANU MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIDANU BIRHANU M.D (PHYSICIAN)
(708) 229-1395
Entity
Organization
Contact information
Practice address
5660 W 95TH ST, SUITE 3, OAK LAWN, IL 60453-2380
(708) 229-1395
(708) 857-4420
Mailing address
5660 W 95TH ST, SUITE 3, OAK LAWN, IL 60453-2380
(708) 229-1395
(708) 857-4420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036072060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633358
BCBS OF IL
IL
01
—
110248456
RAILROAD MEDICARE
IL
Enumeration date
04/19/2007
Last updated
06/24/2010
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