Healthcare Provider Details

I. General information

NPI: 1255487013
Provider Name (Legal Business Name): GENEVIEVE B MELTON-MEAUX MD,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENEVIEVE B MELTON MD, PHD

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MAYO MEDICAL CODE 450
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE MAYO MEDICAL CODE 450
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-9708
  • Fax: 612-626-4199
Mailing address:
  • Phone: 612-624-9708
  • Fax: 612-626-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number50911
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: