MEDICARE: YORDAN MEBRAHTU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver		CO

General Provider Information

NPI Number	:	1619724176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YORDAN MEBRAHTU

Provider Business Mailing Address
First Line	:	6430 MORNING DOVE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-4441
Country	:	US
Telephone Number	:	720-499-7736
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 E 5TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-4249
Country	:	US
Telephone Number	:	720-499-7736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	05/02/2024

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Directions to “ YORDAN MEBRAHTU ” Practice Location

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