Healthcare Provider Details

I. General information

NPI: 1952569931
Provider Name (Legal Business Name): YONATHAN MELMAN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 3450
OGDEN UT
84403-3271
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3850
  • Fax:
Mailing address:
  • Phone: 718-877-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number8983490-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: