Healthcare Provider Details

I. General information

NPI: 1982714960
Provider Name (Legal Business Name): DANIEL A MELINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9767 N 91ST ST #100
SCOTTSDALE AZ
85258-5086
US

IV. Provider business mailing address

3020 E CAMELBACK RD SUITE 301
PHOENIX AZ
85016-5095
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-1990
  • Fax: 480-860-1887
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number21078
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: