Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 01073607 | IN |
NPI | 1053584623 |
---|---|
Provider Name | Dr. Andre G Melendez |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2008 |
Last Update Date | 07/07/2021 |