Healthcare Provider Details

I. General information

NPI: 1922077312
Provider Name (Legal Business Name): DANIEL J MELKUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/26/2012
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: 866-902-2445
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 Number20329
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: