Provider Demographics
NPI:1962427476
Name:SYKES-BELLAMY, MELINDA (MD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:SYKES-BELLAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ESSINGTON RD
Mailing Address - Street 2:STE 230B
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2801
Mailing Address - Country:US
Mailing Address - Phone:815-370-8822
Mailing Address - Fax:877-476-8790
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:STE 230B
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-370-8822
Practice Address - Fax:877-476-8790
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400302411OtherMEDICARE PTAN