Provider Demographics
NPI:1467437293
Name:ZOOK, MELISSA LLENAY (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LLENAY
Last Name:ZOOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:803 MEYERS BAKER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3039
Mailing Address - Country:US
Mailing Address - Phone:606-878-3240
Mailing Address - Fax:606-878-4308
Practice Address - Street 1:803 MEYERS BAKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3039
Practice Address - Country:US
Practice Address - Phone:606-878-3240
Practice Address - Fax:606-878-4308
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081318Medicaid
KYI10120Medicare UPIN
KY64081318Medicaid