Provider Demographics
NPI:1255487013
Name:MELTON-MEAUX, GENEVIEVE B (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:B
Last Name:MELTON-MEAUX
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:DR
Other - First Name:GENEVIEVE
Other - Middle Name:B
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MAYO MEDICAL CODE 450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-9708
Mailing Address - Fax:612-626-4199
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MAYO MEDICAL CODE 450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-624-9708
Practice Address - Fax:612-626-4199
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50911208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery