Provider Demographics
NPI:1336181122
Name:EUGENE P MELE II PSY D PC
Entity type:Organization
Organization Name:EUGENE P MELE II PSY D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-203-8549
Mailing Address - Street 1:410 S MICHIGAN AVE
Mailing Address - Street 2:#707
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1308
Mailing Address - Country:US
Mailing Address - Phone:312-203-8549
Mailing Address - Fax:773-728-7760
Practice Address - Street 1:410 S MICHIGAN AVE
Practice Address - Street 2:#707
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1308
Practice Address - Country:US
Practice Address - Phone:312-203-8549
Practice Address - Fax:773-728-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634589OtherBLUE CROSS BLUE SHIELD
IL1634589OtherBLUE CROSS BLUE SHIELD