MEDICARE: DR. DIXIE MELILLO M.D.

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	208600000X	Surgery Physician	F1815	TX
2	2085R0202X	Diagnostic Radiology Physician	F1815	TX
3	2085U0001X	Diagnostic Ultrasound Physician	F1815	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407857832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIXIE MELILLO M.D.

Provider Business Mailing Address
First Line	:	3343 FAIRVIEW ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1903
Country	:	US
Telephone Number	:	713-944-3000
Fax Number	:	713-941-4534

Provider Business Practice Location Address
First Line	:	3343 FAIRVIEW ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1903
Country	:	US
Telephone Number	:	713-944-3000
Fax Number	:	713-941-4534

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/26/2025

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