Provider Demographics
NPI:1144455221
Name:MICHAEL J. MELECA, MD, LLC
Entity type:Organization
Organization Name:MICHAEL J. MELECA, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELECA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-496-2106
Mailing Address - Street 1:1680 EAGLE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9622
Mailing Address - Country:US
Mailing Address - Phone:614-496-2106
Mailing Address - Fax:614-866-4618
Practice Address - Street 1:417 HILL ROAD NORTH
Practice Address - Street 2:SUITE 801
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-920-3410
Practice Address - Fax:614-920-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064803207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty