Provider Demographics
NPI:1053339937
Name:ILAN MELNICK MD PA
Entity type:Organization
Organization Name:ILAN MELNICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-877-4958
Mailing Address - Street 1:2475 BRICKELL AVE
Mailing Address - Street 2:#2204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2478
Mailing Address - Country:US
Mailing Address - Phone:305-859-9593
Mailing Address - Fax:
Practice Address - Street 1:401 CORAL WAY
Practice Address - Street 2:208A
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4930
Practice Address - Country:US
Practice Address - Phone:786-877-4958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME945632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty