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General NPI Number Information
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NPI Number | 1770713125
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Entity Type | Individual
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Provider Name | CARLOS A MELLA-PICEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 4959 W BELMONT AVE STE N
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City | CHICAGO
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State | IL
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Zip | 60641-4332
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Country | US
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Telephone | 773-930-3642
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Fax | 773-930-3974
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Provider Business Mailing Address
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Address Line | 4959 W BELMONT AVE STE N
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City | CHICAGO
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State | IL
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Zip | 60641-4332
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Country | US
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Telephone | 773-930-3649
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Fax | 773-930-3974
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036.130535
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.056702
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License Number State | IL
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