Basic Information
Provider Information
NPI: 1144216888
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLAMM
FirstName: MELVIN
MiddleName: D
NamePrefix: DR.
NameSuffix: JR.
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1010 HURLEY WAY
Address2: #475
City: SACRAMENTO
State: CA
PostalCode: 958253215
CountryCode: US
TelephoneNumber: 9165616818
FaxNumber: 9165614263
Practice Location
Address1: 5301 F ST
Address2: #117
City: SACRAMENTO
State: CA
PostalCode: 958193226
CountryCode: US
TelephoneNumber: 9167331788
FaxNumber: 9167331787
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 07/10/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XA19838CAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XA19838CAN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
00A19838005CA MEDICAID
P0008484201CARAILROAD MEDICAREOTHER


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