MEDICARE: EDEN ZEWDU WOLDE

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	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1861297970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDEN ZEWDU WOLDE

Provider Business Mailing Address
First Line	:	431 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4004
Country	:	US
Telephone Number	:	614-885-5020
Fax Number	:	614-885-4058

Provider Business Practice Location Address
First Line	:	1288 SHADY LANE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1474
Country	:	US
Telephone Number	:	614-813-6819
Fax Number	:

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

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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Directions to “ EDEN ZEWDU WOLDE ” Practice Location

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