MEDICARE: ALAZAR MELESE BIRHANU

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	347C00000X	Private Vehicle	1FC786	SD
2	347C00000X	Private Vehicle	01724216	SD

General Provider Information

NPI Number	:	1487347423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAZAR MELESE BIRHANU

Provider Business Mailing Address
First Line	:	1201 NORTH HUDSON AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104
Country	:	US
Telephone Number	:	160-594-0932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N HUDSON AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-1042
Country	:	US
Telephone Number	:	605-940-9324
Fax Number	:

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

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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Directions to “ ALAZAR MELESE BIRHANU ” Practice Location

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