Organization
IGOR MELNYCHUK, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY C LU (BILLING/CREDENTIALING SPECIALIST)
(904) 221-2535
Entity
Organization
Contact information
Practice address
14546 OLD SAINT AUGUSTINE RD, SUITE 107, JACKSONVILLE, FL 32258-5468
(904) 352-2466
(904) 352-2472
Mailing address
PO BOX 16292, JACKSONVILLE, FL 32245-6292
(904) 352-2466
(904) 352-2472
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME88142
FL
Other
Enumeration date
05/18/2009
Last updated
06/21/2012
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