Provider Demographics
NPI:1255617353
Name:CAMARDELLA, MELINDA (LAC, MSTOM)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CAMARDELLA
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5201
Mailing Address - Country:US
Mailing Address - Phone:312-731-7474
Mailing Address - Fax:
Practice Address - Street 1:45 S DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1401
Practice Address - Country:US
Practice Address - Phone:847-368-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist