Healthcare Provider Details

I. General information

NPI: 1861411993
Provider Name (Legal Business Name): JULIO C MELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E GRAY ST 652
LOUISVILLE KY
40202-1901
US

IV. Provider business mailing address

234 E GRAY ST 652
LOUISVILLE KY
40202-1901
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-9478
  • Fax: 502-589-4267
Mailing address:
  • Phone: 502-587-9478
  • Fax: 502-589-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01033890A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: