Healthcare Provider Details

I. General information

NPI: 1407874811
Provider Name (Legal Business Name): ALAN L MELOTEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST #1B
BOCA RATON FL
33486-2359
US

IV. Provider business mailing address

951 NW 13TH ST #1B
BOCA RATON FL
33486-2359
US

V. Phone/Fax

Practice location:
  • Phone: 561-750-7509
  • Fax:
Mailing address:
  • Phone: 561-750-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0056918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: