MEDICARE: WALTER MELNYCZENKO 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	207V00000X	Obstetrics & Gynecology Physician	28732	WI

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	:	1811915366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER MELNYCZENKO M.D.

Provider Business Mailing Address
First Line	:	2448 S 102ND ST
Second Line	:	STE 125
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2466
Country	:	US
Telephone Number	:	414-328-3813
Fax Number	:	414-328-3818

Provider Business Practice Location Address
First Line	:	2603 W RAWSON AVE
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-8422
Country	:	US
Telephone Number	:	414-764-1330
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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