Healthcare Provider Details

I. General information

NPI: 1326048588
Provider Name (Legal Business Name): MICHAEL B MELUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JUNCTION HWY STE 220
KERRVILLE TX
78028-4247
US

IV. Provider business mailing address

PO BOX 2600
SAN ANTONIO TX
78299-2600
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-3730
  • Fax:
Mailing address:
  • Phone: 210-692-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK5158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: