Provider Demographics
NPI:1447514096
Name:EDMOND MELIKTERMINAS M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EDMOND MELIKTERMINAS M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKTERMINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-331-7687
Mailing Address - Street 1:303 S GLENOAKS BLVD
Mailing Address - Street 2:# 1
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1319
Mailing Address - Country:US
Mailing Address - Phone:818-331-7687
Mailing Address - Fax:
Practice Address - Street 1:303 S GLENOAKS BLVD
Practice Address - Street 2:# 1
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1319
Practice Address - Country:US
Practice Address - Phone:818-331-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty