Provider Demographics
NPI:1861563421
Name:MELO, ANIBAL GONCALVES (MD)
Entity type:Individual
Prefix:
First Name:ANIBAL
Middle Name:GONCALVES
Last Name:MELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANIBAL
Other - Middle Name:G
Other - Last Name:MELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE 460S
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3608
Mailing Address - Country:US
Mailing Address - Phone:314-682-6500
Mailing Address - Fax:314-552-7276
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:STE 460S
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3608
Practice Address - Country:US
Practice Address - Phone:314-682-6500
Practice Address - Fax:314-552-7276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112089207RN0300X
IL036097259207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG49949Medicare UPIN
MO000095303Medicare ID - Type Unspecified
MOG49949Medicare UPIN
IL202585Medicare ID - Type Unspecified