Individual provider Active NPI

Walter Melnyczenko, M.D.

  • Obstetrics & Gynecology Physician
  • Oak Creek, WI
National Provider Identifier
1811915366
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
28732 Issued in WI
Practice address
2603 W Rawson Ave
Oak Creek, WI 53154-8422
Phone
(414) 764-1330
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 28732 WI Primary

Addresses

Primary practice location

2603 W Rawson Ave
Oak Creek, WI 53154-8422

Mailing address

2448 S 102ND St
Ste 125
West Allis, WI 53227-2466
Phone (414) 328-3813

Other identifiers 1

IdentifierTypeStateIssuer
30817100MedicaidWI

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Genetics Institute, S.C. CurrentSince Sep 1, 2004 Accepting new patients
Clinic of Obstetrics and Gynecology, LTD. Obstetrics & Gynecology Past Accepting new patients
Affiliated Podiatrists SC PastSince Nov 1, 1998 Accepting new patients

Locations

4220 S 27th St
Ste 101
Milwaukee, WI 53221
Phone (414) 281-5480

1626 W Fond du Lac Ave
Ste 111
Milwaukee, WI 53205
Phone (414) 287-1000

1626 W Fond du Lac Ave
Ste 110
Milwaukee, WI 53205
Phone (414) 228-0100

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811915366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2448 S 102ND ST",
            "address_2": "STE 125",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272466",
            "telephone_number": "414-328-3813",
            "fax_number": "414-328-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 W RAWSON AVE",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548422",
            "telephone_number": "414-764-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELNYCZENKO",
        "first_name": "WALTER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "28732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30817100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Creek, WI

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.

Verify at the official NPI Registry.