Provider Demographics
NPI:1245202084
Name:MELGEN, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MELGEN
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 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 902
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-854-0302
Mailing Address - Fax:305-854-0308
Practice Address - Street 1:3641 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4205
Practice Address - Country:US
Practice Address - Phone:305-854-0302
Practice Address - Fax:305-854-0308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87484207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71468OtherBLUE CROSS BLUE SHIELD
FLH96598Medicare UPIN
71468YMedicare ID - Type Unspecified