Provider Demographics
NPI:1790199933
Name:MELVANI, VINESH R
Entity type:Individual
Prefix:
First Name:VINESH
Middle Name:R
Last Name:MELVANI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WILLOW SPRINGS RD STE 430
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6538
Mailing Address - Country:US
Mailing Address - Phone:708-482-3213
Mailing Address - Fax:708-482-3230
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 430
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6538
Practice Address - Country:US
Practice Address - Phone:708-482-3213
Practice Address - Fax:708-482-3230
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-065169207R00000X
IL036153348207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine