Provider Demographics
NPI:1619422649
Name:GEORGE MELLOS MD PLLC
Entity Type:Organization
Organization Name:GEORGE MELLOS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-949-8886
Mailing Address - Street 1:28890 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3154
Mailing Address - Country:US
Mailing Address - Phone:248-949-8886
Mailing Address - Fax:
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:STE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010505952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty