Healthcare Provider Details

I. General information

NPI: 1326240029
Provider Name (Legal Business Name): GREG MELNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 FISHER ISLAND DR
MIAMI BEACH FL
33109-0049
US

IV. Provider business mailing address

2114 FISHER ISLAND DR
MIAMI BEACH FL
33109-0049
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-1411
  • Fax:
Mailing address:
  • Phone: 305-674-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME 33629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: