Individual
IGOR MELNYCHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14546 OLD ST AUGUSTINE RD, SUITE 107, JACKSONVILLE, FL 32258
(904) 352-2466
(904) 352-2472
Mailing address
P.O. BOX 16292, SUITE 107, JACKSONVILLE, FL 32245
(904) 352-2466
(904) 352-2472
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME88142
FL
207RI0200X
Infectious Disease Physician
Primary
ME88142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268770401
—
FL
Enumeration date
10/04/2006
Last updated
10/06/2011
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