Provider Demographics
NPI:1053916437
Name:ENGDASHET, MIKIYAS TESFAYE
Entity type:Individual
Prefix:
First Name:MIKIYAS
Middle Name:TESFAYE
Last Name:ENGDASHET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 E 11TH AVE
Mailing Address - Street 2:1311
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-668-6807
Mailing Address - Fax:
Practice Address - Street 1:8001 E 11TH AVE
Practice Address - Street 2:1311
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-8022
Practice Address - Country:US
Practice Address - Phone:303-668-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COXOH148347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle