Provider Demographics
NPI:1407857832
Name:MELILLO, DIXIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIXIE
Middle Name:
Last Name:MELILLO
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 1:3343 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1903
Mailing Address - Country:US
Mailing Address - Phone:713-944-3000
Mailing Address - Fax:713-941-4534
Practice Address - Street 1:3343 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1903
Practice Address - Country:US
Practice Address - Phone:713-944-3000
Practice Address - Fax:713-941-4534
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF18152085R0202X, 2085U0001X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1140329-02Medicaid
TXB24842Medicare UPIN