Kidanu Birhanu, M.D.
Individual provider Active NPI Internal Medicine Physician · Dyer, IN
NPI 1710073952 · NPPES record last updated Mar 30, 2016
Key facts
- NPI
- 1710073952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 01066132 (IN)
- Practice address
- 24 Joliet St
Ste 302
Dyer, IN 46311-1705 - Phone
- (219) 852-2518
- Fax
- (219) 864-2156
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
2850 W 95TH St
Suite 406
Evergreen Park, IL 60805-2790
Phone (708) 229-6651
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
Hospital & facility affiliations
- Osf Little Company of Mary Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071031000477 | IL | Practitioner - Internal Medicine |
0143317685 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01066132 | IN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osf Multi-Specialty Group | Internal Medicine | Current |
Accepting new patients |
| Central PA Pharmacy LLC. | Current | Accepting new patients |
Locations
2800 W 95th St
Ste 100
Evergreen Pk, IL 60805
Phone (708) 422-6200
5660 W 95th St
Ste 3
Oak Lawn, IL 60453
Phone (708) 229-1395
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01066132 | IN | Yes |
| Internal Medicine Physician | 207R00000X | 036072060 | IL |
Addresses
Primary practice location
24 Joliet St
Ste 302
Dyer, IN 46311-1705
Mailing address
24 Joliet St
Ste 302
Dyer, IN 46311-1705
Phone (219) 852-2518
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036072060 | Medicaid | IL | |
| 01633358 | Other | IL | BCBS OF IL |
| 110248456 | Other | IL | MEDICARE RAILROAD |
Other names
- Kidanu Birhanu
Other providers in Dyer, IN
- Daniel P Benjamin
- Kathryn Lee Bernath
- Jocelyn Denise Betts
- Umar Bhatti
- Bio-Medical Applications of Indiana, Inc.
- Lara Marie Blanchard
- Christina Blazo
- Christina Bocken
- Mohen Bohjwani
- Angela Boose
All providers in Dyer, IN · Internal Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.