Provider Demographics
NPI:1518090026
Name:MELIKER, MARTIN LARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LARRY
Last Name:MELIKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 N PROCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1345
Mailing Address - Country:US
Mailing Address - Phone:847-259-8687
Mailing Address - Fax:
Practice Address - Street 1:3945 N PROCTOR CIR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1345
Practice Address - Country:US
Practice Address - Phone:847-259-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical