Provider Demographics
NPI:1326118332
Name:SHARAFUDDIN, MELHEM J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELHEM
Middle Name:J
Last Name:SHARAFUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MELHEM
Other - Middle Name:J
Other - Last Name:CHARAFEDDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-624-2416
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-364-8346
Practice Address - Fax:719-364-8347
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA278952085R0204X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE73715Medicare UPIN