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General NPI Number Information
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NPI Number | 1063687804
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Entity Type | Organization
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Legal Business Name | OTILIO MELERO MDSC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 5430 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2620
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Country | US
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Telephone | 773-471-2411
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Fax | 773-471-9703
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Provider Business Mailing Address
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Address Line | 5430 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2620
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Country | US
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Telephone | 773-471-2411
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Fax | 773-471-9703
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OTILIO N MELERO
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Credential | MD
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Telephone | 773-471-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036069929
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License Number State | IL
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