Provider Demographics
NPI:1952798449
Name:MEDINA, MELISSA GO (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GO
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:705 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2684
Mailing Address - Country:US
Mailing Address - Phone:224-659-0349
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5969
Practice Address - Country:US
Practice Address - Phone:312-664-3278
Practice Address - Fax:312-695-5774
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036166181208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)