Healthcare Provider Details

I. General information

NPI: 1477543692
Provider Name (Legal Business Name): RAMON MELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 W FRANKLIN BLVD
CHICAGO IL
60624-1511
US

IV. Provider business mailing address

3240 W FRANKLIN BLVD
CHICAGO IL
60624-1511
US

V. Phone/Fax

Practice location:
  • Phone: 773-722-3020
  • Fax:
Mailing address:
  • Phone: 773-722-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: