Healthcare Provider Details

I. General information

NPI: 1891896924
Provider Name (Legal Business Name): MELKUS DIAGNOSTIC RADIOLOGY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 BEL AIR RD
NORFOLK NE
68701-2663
US

IV. Provider business mailing address

PO BOX 391
NORFOLK NE
68702-0391
US

V. Phone/Fax

Practice location:
  • Phone: 308-647-6444
  • Fax:
Mailing address:
  • Phone: 308-647-6444
  • Fax: 866-902-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J MELKUS
Title or Position: OWNER
Credential: MD
Phone: 308-647-6444