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NPI Code Detail

MEDICARE: MELISSA M. PENAS M.D.

MEDICARE: MELISSA M. PENAS 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
1207L00000XAnesthesiology PhysicianIL

General Provider Information

NPI Number : 1649272618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA M. PENAS M.D.
Provider Business Mailing Address
First Line : 1770 1ST ST
Second Line : SUITE 703
City : HIGHLAND PARK
State : IL
Zip : 60035-3200
Country : US
Telephone Number : 847-433-1539
Fax Number : 847-433-1552
Provider Business Practice Location Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-484-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 11/30/2007

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