Individual
MELISSA M. M. AGOUDEMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
520 S EAGLE RD, SUITE 2204, MERIDIAN, ID 83642-6351
(208) 336-9188
(208) 336-2636
Mailing address
520 S EAGLE RD, SUITE 2204, MERIDIAN, ID 83642-6351
(208) 336-9188
(208) 336-2636
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R-8001
IA
2080P0202X
Pediatric Cardiology Physician
Primary
036-125447
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125447
—
IL
Enumeration date
05/21/2007
Last updated
04/18/2017
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