Provider Demographics
NPI:1790199933
Name:MELVANI, VINESH
Entity Type:Individual
Prefix:
First Name:VINESH
Middle Name:
Last Name:MELVANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5453
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:773-862-1454
Practice Address - Street 1:1776 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5453
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:773-862-1454
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-065169207R00000X
IL036153348207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine