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General NPI Number Information
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NPI Number | 1679761563
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Entity Type | Organization
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Legal Business Name | MELVIN C. LU, M.D., LLC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 10133 CORTEZ BLVD.
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6385
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Country | US
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Telephone | 352-596-4401
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Fax | 352-596-4431
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Provider Business Mailing Address
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Address Line | 10133 CORTEZ BLVD.
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6385
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Country | US
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Telephone | 352-596-4401
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Fax | 352-596-4431
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. MELVIN C LU
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Credential | MD
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Telephone | 352-596-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME70999
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | ME70999
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | ME70999
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2766
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME70999
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License Number State | FL
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