Healthcare Provider Details

I. General information

NPI: 1942300751
Provider Name (Legal Business Name): MEIR HERZL MELMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGE GUTE PARKWAY, SUITE 280
LONE TREE CO
80124
US

IV. Provider business mailing address

10099 RIDGE GUTE PARKWAY, SUITE 280
LONE TREE CO
80124
US

V. Phone/Fax

Practice location:
  • Phone: 303-791-2112
  • Fax: 303-683-6415
Mailing address:
  • Phone: 303-791-2112
  • Fax: 303-683-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number21140
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: