Healthcare Provider Details

I. General information

NPI: 1144455221
Provider Name (Legal Business Name): MICHAEL J. MELECA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 HILL ROAD NORTH SUITE 801
PICKERINGTON OH
43147
US

IV. Provider business mailing address

1680 EAGLE GLEN DR
BLACKLICK OH
43004-9622
US

V. Phone/Fax

Practice location:
  • Phone: 614-920-3410
  • Fax: 614-920-3413
Mailing address:
  • Phone: 614-496-2106
  • Fax: 614-866-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-064803
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number35-064803
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL J. MELECA
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 614-496-2106