MEDICARE: GERARDO MANUEL HEREDIA MELERO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	01099156A	IN
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	50803	KY
3	207V00000X	Obstetrics & Gynecology Physician	50803	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174839401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO MANUEL HEREDIA MELERO M.D.

Provider Business Mailing Address
First Line	:	125 E MAXWELL ST STE 300
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-2678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR STE 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-425-5240
Fax Number	:	260-425-5245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	03/19/2026

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Directions to “ GERARDO MANUEL HEREDIA MELERO M.D.” Practice Location

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