Provider Demographics
NPI:1285632752
Name:MELNICK, LORRY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORRY
Middle Name:A
Last Name:MELNICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S ONEIDA ST
Mailing Address - Street 2:STE 270
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2549
Mailing Address - Country:US
Mailing Address - Phone:303-355-1995
Mailing Address - Fax:303-355-1834
Practice Address - Street 1:2121 S ONEIDA ST
Practice Address - Street 2:STE 270
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2549
Practice Address - Country:US
Practice Address - Phone:303-355-1995
Practice Address - Fax:303-355-1834
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-01-03
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CO308213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC54173OtherMEDICARE
CO01003086Medicaid
CO480022479OtherMEDICARE RAILROAD
CO480022479OtherMEDICARE RAILROAD
COC54173OtherMEDICARE
263639YVUZMedicare PIN
CO01003086Medicaid