Provider Demographics
NPI:1932589868
Name:MELCHOR, LINZI (LMT)
Entity Type:Individual
Prefix:
First Name:LINZI
Middle Name:
Last Name:MELCHOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1201
Mailing Address - Country:US
Mailing Address - Phone:773-472-0700
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:1255 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1201
Practice Address - Country:US
Practice Address - Phone:773-472-0700
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist