Provider Demographics
NPI:1851650857
Name:EMMANUEL G. MELISSINOS, M.D., P.A.
Entity Type:Organization
Organization Name:EMMANUEL G. MELISSINOS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MELISSINOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-0723
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:1220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:713-790-0723
Mailing Address - Fax:713-790-0743
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:1220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-790-0723
Practice Address - Fax:713-790-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
F6038208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110263402Medicaid
B24843Medicare UPIN