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1720936669 NPI number — SEMEKIDUS SHIFERAWE

NPI Number: 1720936669
Health Care Provider/Practitioner: SEMEKIDUS SHIFERAWE

Information about “1720936669” NPI (SEMEKIDUS SHIFERAWE) exists in 1720936669 in HTML format HTML  |  1720936669 in plain Text format TXT  |  1720936669 in PDF (Portable Document Format) PDF  |  1720936669 in an XML format XML  formats.

NPI Number : 1720936669 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720936669",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIFERAWE",
    "FirstName": "SEMEKIDUS",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHIFERAWE",
    "OtherFirstName": "KIDUS",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "440 SQUIRES RD APT 9103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEXINGTON",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40515-5753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-408-6507",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "780 ROSE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LEXINGTON",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40536-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "859-323-6161",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/17/2026",
    "LastUpdateDate": "03/17/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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