Provider Demographics
NPI:1831256510
Name:MELZER, DARYL JOHN (MD)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:JOHN
Last Name:MELZER
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 1:13950 W CAPITOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:414-302-5404
Mailing Address - Fax:414-302-5405
Practice Address - Street 1:13950 W CAPITOL DRIVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:414-302-5404
Practice Address - Fax:414-302-5405
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3908168571A4OtherBLUE CROSS BLUE SHIELD
WI30307500Medicaid
3908168571A4OtherBLUE CROSS BLUE SHIELD
WI30307500Medicaid