Provider Demographics
NPI:1376596346
Name:MELCHERT, MAGDA ELKABANI (MD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:ELKABANI
Last Name:MELCHERT
Suffix:
Gender:F
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:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:403 S KINGS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5962
Practice Address - Country:US
Practice Address - Phone:813-982-3460
Practice Address - Fax:813-982-3461
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88929207RH0000X, 207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00727035OtherRR MEDICARE
FL275257300Medicaid
FLP00727035OtherRR MEDICARE
FLI56320Medicare UPIN