Provider Demographics
NPI:1407035611
Name:MELISSA ROBLEDO MD SC
Entity Type:Organization
Organization Name:MELISSA ROBLEDO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-677-7502
Mailing Address - Street 1:PO BOX 9071
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9071
Mailing Address - Country:US
Mailing Address - Phone:847-677-7502
Mailing Address - Fax:847-677-7516
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:807
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-677-7502
Practice Address - Fax:847-677-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL035100559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00149077OtherRAILROAD MEDICARE
IL0001633810OtherBC
IL60054OtherAETNA
IL62308OtherCIGNA
ILP00149077OtherRAILROAD MEDICARE
IL60054OtherAETNA