Provider Demographics
NPI:1437197381
Name:MELE, EUGENE P (PSYD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
Last Name:MELE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MICHIGAN AVE STE 70
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1308
Mailing Address - Country:US
Mailing Address - Phone:312-203-8549
Mailing Address - Fax:773-728-7760
Practice Address - Street 1:410 S MICHIGAN AVE
Practice Address - Street 2:#707
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1308
Practice Address - Country:US
Practice Address - Phone:312-203-8549
Practice Address - Fax:773-728-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634589OtherBLUE CROSS BLUE SHIELD
IL1634589OtherBLUE CROSS BLUE SHIELD