Provider Demographics
NPI:1679761563
Name:MELVIN C. LU, M.D., LLC
Entity Type:Organization
Organization Name:MELVIN C. LU, M.D., LLC
Other - Org Name:LIEN & LU, M.D'S P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-4401
Mailing Address - Street 1:10133 CORTEZ BLVD.
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6385
Mailing Address - Country:US
Mailing Address - Phone:352-596-4401
Mailing Address - Fax:352-596-4431
Practice Address - Street 1:10133 CORTEZ BLVD.
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6385
Practice Address - Country:US
Practice Address - Phone:352-596-4401
Practice Address - Fax:352-596-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70999207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
FLPA2766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI5866OtherMEDICARE RAILROAD
38300AOtherBCBS GROUP NUMBER
38300OtherBCBS GROUP NUMBER
38300OtherBCBS GROUP NUMBER
38300AOtherBCBS GROUP NUMBER
CI5866OtherMEDICARE RAILROAD
K0655AMedicare PIN
K0655Medicare PIN