Organization
NORTHWEST EXTREMITY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS CHARLES MELILLO DPM (OWNER)
(503) 245-2420
Entity
Organization
Contact information
Practice address
9115 SW OLESON RD STE 205, PORTLAND, OR 97223-6877
(503) 245-2420
(503) 245-2445
Mailing address
9115 SW OLESON RD STE 205, PORTLAND, OR 97223-6877
(503) 245-2420
(503) 245-2445
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00330
OR
Other
Enumeration date
10/28/2015
Last updated
01/06/2021
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