Provider Demographics
NPI:1194800318
Name:MELANY, MICHELLE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:MELANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:SUITE M335
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-5055
Mailing Address - Fax:310-423-0248
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:SUITE M335
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-5055
Practice Address - Fax:310-423-0248
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG683352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG68335BMedicare ID - Type Unspecified
CAF80750Medicare UPIN