Agoudemos, Melissa M. M.

Agoudemos, Melissa M. M. is an individual health care provider with primary practice located at 520 S Eagle Rd Suite 2204, Meridian ID 83642-6351. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Cardiology. Allopathic & Osteopathic Physicians / Pediatric Cardiology is her primary health care specialty. Agoudemos, Melissa M. M. can be contacted via phone (208) 336-9188.

Contact Information

Primary practice address
520 S Eagle Rd Suite 2204 Meridian ID 83642-6351
Phone: (208) 336-9188
Fax: (208) 336-2636
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X R-8001 Iowa
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X 036-125447 Illinois

Profile Details

NPI number 1518175579
LBN Legal business name Agoudemos, Melissa M. M.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 21st, 2007
Last updated Apr 18th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518175579 NPPES
Illinois MEDICAID 036125447

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