Provider Demographics
NPI:1235217373
Name:MELAMED, JULIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:MELAMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 LAKE COOK RD STE 295
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4932
Mailing Address - Country:US
Mailing Address - Phone:847-418-3308
Mailing Address - Fax:847-418-3309
Practice Address - Street 1:707 LAKE COOK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5613
Practice Address - Country:US
Practice Address - Phone:847-418-3308
Practice Address - Fax:847-418-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095792Medicaid
ILG86804Medicare UPIN