Active NPI
Michael Gerardo Melendez, MD
- Diagnostic Radiology Physician
- Coeur D Alene, ID
National Provider Identifier
1013080787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- M-3755
- Practice address
- 2789 E Spyglass CT
Coeur D Alene, ID 83815 - Phone
- (208) 610-0041
- Fax
- (208) 777-1313
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | M-3755 | ID | Primary |
| Diagnostic Radiology Physician | 2085R0202X | 160913-1205 | UT |
Addresses
Primary practice location
2789 E Spyglass CT
Coeur D Alene, ID 83815
Mailing address
2789 E Spyglass CT
Coeur D Alene, ID 83815
Phone (208) 762-0288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8111379 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-3755 | ID | MD | Diagnostic Radiology Physician |
| 160913-1205 | UT | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013080787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2789 E SPYGLASS CT",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "83815",
"telephone_number": "208-762-0288",
"fax_number": "208-777-1313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2789 E SPYGLASS CT",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "83815",
"telephone_number": "208-610-0041",
"fax_number": "208-777-1313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELENDEZ",
"first_name": "MICHAEL",
"middle_name": "GERARDO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "ID",
"license": "M-3755",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "UT",
"license": "160913-1205",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8111379",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.