Provider Demographics
NPI:1164687331
Name:RIVERA-MELENDEZ, JOSE J (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:RIVERA-MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:JUAN
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 W UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1874
Mailing Address - Country:US
Mailing Address - Phone:248-402-0266
Mailing Address - Fax:
Practice Address - Street 1:2775 BLAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8838
Practice Address - Country:US
Practice Address - Phone:517-787-2906
Practice Address - Fax:517-787-3039
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104505207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110096196AMedicaid
MA003319601Medicare PIN