Provider Demographics
NPI:1932108685
Name:FUKUI, MELANIE B (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:B
Last Name:FUKUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W. CENTRAL RD. #7400
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-618-4430
Mailing Address - Fax:847-618-0786
Practice Address - Street 1:880 W. CENTRAL RD. #7400
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-618-4430
Practice Address - Fax:847-618-0786
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041474L2085R0202X
IL0361594862085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05020Medicare UPIN