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General NPI Number Information
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NPI Number | 1902192438
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Entity Type | Individual
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Provider Name | MELVIN EMEKA OMODON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036146488
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25IA12313800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 4301099187
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME140585
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 269481
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036146488
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License Number State | IL
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