Provider Demographics
NPI:1437613080
Name:MELE MEDICINE LLC
Entity Type:Organization
Organization Name:MELE MEDICINE LLC
Other - Org Name:SANDRA V MELE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MELE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-258-0489
Mailing Address - Street 1:2925 E RIGGS RD
Mailing Address - Street 2:STE.8 PMB179
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3600
Mailing Address - Country:US
Mailing Address - Phone:951-201-7756
Mailing Address - Fax:480-718-7313
Practice Address - Street 1:1301 S CRISMON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3767
Practice Address - Country:US
Practice Address - Phone:951-201-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ398267Medicaid