Provider Demographics
NPI:1457389371
Name:MELNICK, MICHAEL PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:MELNICK
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 1:650 W LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2082
Mailing Address - Country:US
Mailing Address - Phone:847-459-1160
Mailing Address - Fax:847-459-8692
Practice Address - Street 1:650 W LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2082
Practice Address - Country:US
Practice Address - Phone:847-459-1160
Practice Address - Fax:847-459-8692
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE46737Medicare UPIN
IL93073Medicare ID - Type UnspecifiedMEDICARE NUMBER