Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 02003069A | IN |
NPI | 1174561211 |
---|---|
Provider Name | Dr. Matthew Paul Melander |
First Address | Saint Louis, MO 63128-2786 |
Second Address | O Fallon, MO 63368-4281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 18/07/2019 |