Healthcare Provider Details

I. General information

NPI: 1467437293
Provider Name (Legal Business Name): MELISSA LLENAY ZOOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MEYERS BAKER RD SUITE 200
LONDON KY
40741-3039
US

IV. Provider business mailing address

803 MEYERS BAKER RD SUITE 200
LONDON KY
40741-3039
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-3240
  • Fax: 606-878-4308
Mailing address:
  • Phone: 606-878-3240
  • Fax: 606-878-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38795
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: