MEDICARE: MELANIE B FUKUI MD

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	2085R0202X	Diagnostic Radiology Physician	MD041474L	PA
2	2085N0700X	Neuroradiology Physician	036159486	IL

General Provider Information

NPI Number	:	1932108685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE B FUKUI MD

Provider Business Mailing Address
First Line	:	880 W. CENTRAL RD. #7400
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-618-4430
Fax Number	:	847-618-0786

Provider Business Practice Location Address
First Line	:	880 W. CENTRAL RD. #7400
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-618-4430
Fax Number	:	847-618-0786

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	05/26/2022

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Directions to “ MELANIE B FUKUI MD” Practice Location

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