Provider Demographics
NPI:1265620652
Name:ALAN L MELOTEK MD PA
Entity type:Organization
Organization Name:ALAN L MELOTEK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MELOTEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-750-7509
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:#1B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-750-7509
Mailing Address - Fax:561-750-7106
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:#1B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2359
Practice Address - Country:US
Practice Address - Phone:561-750-7509
Practice Address - Fax:561-750-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056918207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2320OtherMEDICARE GROUP PROVIDER #