Provider Demographics
NPI:1922077312
Name:MELKUS, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MELKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-0391
Mailing Address - Country:US
Mailing Address - Phone:308-647-6444
Mailing Address - Fax:866-902-2445
Practice Address - Street 1:1603 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2663
Practice Address - Country:US
Practice Address - Phone:308-647-6444
Practice Address - Fax:866-902-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE203292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE272304Medicare ID - Type Unspecified
C31256Medicare UPIN