Organization
KIDANU BIRHANU MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIDANU BIRHANU MD (OWNER)
(708) 334-2352
Entity
Organization
Contact information
Practice address
24 JOLIET ST, SUITE 302, DYER, IN 46311-1705
(219) 852-2518
(219) 864-2156
Mailing address
PO BOX 394, DYER, IN 46311-0394
(708) 334-2352
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
01066132A
IN
Other
Enumeration date
06/28/2010
Last updated
06/28/2010
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