Healthcare Provider Details

I. General information

NPI: 1356760912
Provider Name (Legal Business Name): MELLANI LEFTA MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 POPLAR LEVEL RD
LOUISVILLE KY
40217-1301
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-4929
  • Fax: 502-394-3629
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50043
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: