Provider Demographics
NPI:1568567857
Name:MELEKS, LARISA (DO)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:MELEKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14400 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2703
Mailing Address - Country:US
Mailing Address - Phone:941-423-5056
Mailing Address - Fax:941-423-5068
Practice Address - Street 1:14400 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2703
Practice Address - Country:US
Practice Address - Phone:941-423-5056
Practice Address - Fax:941-423-5068
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49313OtherBCBS
FLP00282509OtherRR MEDICARE
FL7993105OtherAETNA
FL10715566OtherCAQH