Healthcare Provider Details

I. General information

NPI: 1285632752
Provider Name (Legal Business Name): LORRY A MELNICK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

2121 S ONEIDA ST STE 270
DENVER CO
80224-2549
US

IV. Provider business mailing address

2121 S ONEIDA ST STE 270
DENVER CO
80224-2549
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-1995
  • Fax: 303-355-1834
Mailing address:
  • Phone: 303-355-1995
  • Fax: 303-355-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number308
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: