Provider Demographics
NPI:1316951304
Name:DEMETRIA, MELCHOR V (MD)
Entity type:Individual
Prefix:
First Name:MELCHOR
Middle Name:V
Last Name:DEMETRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W WOLFRAM ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5180
Mailing Address - Country:US
Mailing Address - Phone:312-864-3251
Mailing Address - Fax:312-864-9322
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3251
Practice Address - Fax:312-864-9322
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087099207R00000X, 207RG0100X
IL036-087099207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology