# MEDI MELBOURNE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700256450
- **Authorized official:** THOMAS K WILLETT (MANAGING MEMBER)
- **Authorized official phone:** (813) 245-5305

## Contact information

- **Practice address:** 7630 N WICKHAM RD, SUITE 104, MELBOURNE, FL 32940-8257
- **Practice address phone:** (321) 610-7982
- **Mailing address:** 412 E MADISON ST, SUITE 1100, TAMPA, FL 33602-4601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2015
- **Last updated:** 10/26/2016