Healthcare Provider Details

I. General information

NPI: 1154468833
Provider Name (Legal Business Name): ADDISU MESFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 665
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 665
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5196
  • Fax: 585-756-4726
Mailing address:
  • Phone: 585-275-5196
  • Fax: 585-756-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2011001620
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number266455
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number266455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: