Provider Demographics
NPI:1679577621
Name:MELONAKOS, ANTHONY EMMANUEL (MD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EMMANUEL
Last Name:MELONAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1420 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4211
Mailing Address - Country:US
Mailing Address - Phone:734-241-0042
Mailing Address - Fax:734-384-0469
Practice Address - Street 1:1420 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4211
Practice Address - Country:US
Practice Address - Phone:734-241-0042
Practice Address - Fax:734-384-0469
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040131207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2119491Medicaid
MIA78033Medicare UPIN
MI2119491Medicaid