Healthcare Provider Details

I. General information

NPI: 1760432264
Provider Name (Legal Business Name): DONALD LEWIN MELLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 SHIPWATCH CIR
TAMPA FL
33602-5786
US

IV. Provider business mailing address

15164 MORENO BEACH DR. APT. 1522
MORENO VALLEY CA
92555
US

V. Phone/Fax

Practice location:
  • Phone: 813-205-2702
  • Fax: 813-354-3623
Mailing address:
  • Phone: 970-371-2861
  • Fax: 813-354-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME 22145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: