# MELMAR LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indiana Vein and Laser Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356544308
- **Authorized official:** DR. MARCUS A JIMENEZ M.D. (COO)
- **Authorized official phone:** (260) 432-7654

## Contact information

- **Practice address:** 2410 N GLENDALE DR, SUITE C, FORT WAYNE, IN 46804-8908
- **Practice address phone:** (260) 432-7654
- **Practice address fax:** (260) 432-7709
- **Mailing address:** 2410 N GLENDALE DR, SUITE C, FORT WAYNE, IN 46804-8908
- **Mailing address phone:** (260) 432-7654
- **Mailing address fax:** (260) 432-7709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 01043881A | IN | Yes |

## Other

- **Enumeration date:** 06/07/2007
- **Last updated:** 08/22/2020