Provider Demographics
NPI:1235113747
Name:MELNIK, IOURI (MD)
Entity Type:Individual
Prefix:MR
First Name:IOURI
Middle Name:
Last Name:MELNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4723
Mailing Address - Country:US
Mailing Address - Phone:773-276-8600
Mailing Address - Fax:773-276-8601
Practice Address - Street 1:2323 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4723
Practice Address - Country:US
Practice Address - Phone:773-276-8600
Practice Address - Fax:773-276-8601
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632565OtherBCBS ILLINOIS
IL036094506Medicaid
ILK45666Medicare PIN
ILH 01174Medicare UPIN
IL203898Medicare PIN