Provider Demographics
NPI:1518526797
Name:DIZON, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:DIZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 N LINCOLN AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1766
Mailing Address - Country:US
Mailing Address - Phone:847-983-8356
Mailing Address - Fax:888-909-5815
Practice Address - Street 1:744 LESLIE LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-2612
Practice Address - Country:US
Practice Address - Phone:847-983-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management