Provider Demographics
NPI:1184640401
Name:FLYE, MELVYN W (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:W
Last Name:FLYE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8109
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7145
Mailing Address - Fax:314-747-4871
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:SUITE A FLOOR 8
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7145
Practice Address - Fax:314-747-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-08-13
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Provider Licenses
StateLicense IDTaxonomies
MOR1F492085R0204X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202141404Medicaid
IL$$$$$$$$$Medicaid
IL$$$$$$$$$Medicaid
MO202141404Medicaid