MEDICARE: EUGENE P MELE PSY.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	103G00000X	Clinical Neuropsychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1634589	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1437197381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE P MELE PSY.D.

Provider Business Mailing Address
First Line	:	410 S MICHIGAN AVE STE 70
Second Line	:	SUITE 406
City	:	CHICAGO
State	:	IL
Zip	:	60605-1308
Country	:	US
Telephone Number	:	312-203-8549
Fax Number	:	773-728-7760

Provider Business Practice Location Address
First Line	:	410 S MICHIGAN AVE
Second Line	:	#707
City	:	CHICAGO
State	:	IL
Zip	:	60605-1308
Country	:	US
Telephone Number	:	312-203-8549
Fax Number	:	773-728-7760

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	03/03/2016

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