Individual
MELISSA JIAYU FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-1200
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-1200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125079211
IL
390200000X
Student in an Organized Health Care Education/Training Program
1376121715
NM
Other
Enumeration date
03/29/2021
Last updated
05/29/2022
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