Individual
HAILEMARIAM MEKITE WOLDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-4423
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
265792
NY
208M00000X
Hospitalist Physician
Primary
265792
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/03/2009
Last updated
10/19/2020
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