Provider Demographics
NPI:1871590935
Name:ABORDO, MELECIO G JR (MD)
Entity type:Individual
Prefix:
First Name:MELECIO
Middle Name:G
Last Name:ABORDO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JACKSON HTS
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-6500
Mailing Address - Country:US
Mailing Address - Phone:606-693-0199
Mailing Address - Fax:606-666-9480
Practice Address - Street 1:12 JACKSON HTS
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-6500
Practice Address - Country:US
Practice Address - Phone:606-693-0199
Practice Address - Fax:606-666-9480
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34645207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64364458Medicaid
KY64364458Medicaid
KYH30976Medicare UPIN