Basic Information
| Provider Information | |||||||||
| NPI: | 1891896924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MELKUS DIAGNOSTIC RADIOLOGY SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 391 | ||||||||
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| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687020391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
| FaxNumber: | 8669022445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1603 BEL AIR RD | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687012663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | MELKUS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3086476444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.