Individual
KIDANU BIRHANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 JOLIET ST, STE 302, DYER, IN 46311-1705
(219) 852-2518
(219) 864-2156
Mailing address
24 JOLIET ST, STE 302, DYER, IN 46311-1705
(219) 852-2518
(219) 864-2156
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01066132
IN
207R00000X
Internal Medicine Physician
036072060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633358
BCBS OF IL
IL
05
—
036072060
—
IL
01
—
110248456
MEDICARE RAILROAD
IL
Enumeration date
10/05/2006
Last updated
03/30/2016
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