Kidanu Birhanu MD SC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

01066132A Issued in IN

Legal business name

KIDANU BIRHANU MD SC

Practice address

24 Joliet St
Suite 302
Dyer, IN 46311-1705

Phone

(219) 852-2518

Fax

(219) 864-2156

NPI assigned

Jun 28, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kidanu Birhanu, MD

Title

Owner

Phone

(708) 334-2352

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277683200000",
    "number": "1619288339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 394",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463110394",
            "telephone_number": "708-334-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 JOLIET ST",
            "address_2": "SUITE 302",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111705",
            "telephone_number": "219-852-2518",
            "fax_number": "219-864-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDANU BIRHANU MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2010-06-28",
        "status": "A",
        "authorized_official_last_name": "BIRHANU",
        "authorized_official_first_name": "KIDANU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-334-2352",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IN",
            "license": "01066132A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barry J Kaufman, D.O.
• Carla Kersten
• Anali Khalil
• Amena Khazaran
• Marco N. Khiella, MD
• Nathan Henry Kies, OTD
• Stacey Lynn Killeen, M.A, CCC-SLP
• Stephen K Kimani, LCSW
• Angela Klukken, OT
• Heather Kmiecik, FNP-BC

• Clinic/Center in Dyer, IN
• Providers in Dyer, IN by specialty
• Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.