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General NPI Number Information
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NPI Number | 1457640062
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Entity Type | Individual
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Provider Name | ERIC ALBERT MELLON M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 2800 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2610
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Country | US
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Telephone | 888-777-4167
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME117891
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 4301514121
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License Number State | MI
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