Basic Information
| Provider Information | |||||||||
| NPI: | 1598707655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDIOLA | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 NOBLE PKWY N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554435500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632365300 | ||||||||
| FaxNumber: | 7632365250 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 NOBLE PKWY N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554435500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632365300 | ||||||||
| FaxNumber: | 7632365250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 46382 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.