Provider Demographics
NPI:1982660866
Name:MELCHIONNA, KENNETH V (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:V
Last Name:MELCHIONNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SPRINGHILL RING ROAD
Mailing Address - Street 2:SUITE #2020
Mailing Address - City:DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118
Mailing Address - Country:US
Mailing Address - Phone:847-426-0227
Mailing Address - Fax:847-426-0299
Practice Address - Street 1:650 SPRINGHILL RING ROAD
Practice Address - Street 2:SUITE #2020
Practice Address - City:DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-426-0227
Practice Address - Fax:847-426-0299
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL56358Medicare PIN
ILF22974Medicare UPIN
ILL31338Medicare PIN