Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 4301077478 | MI |
NPI | 1023082880 |
---|---|
Provider Name | Melissa Lynn Meldrum |
First Address | Grand Rapids, MI 49525-5807 |
Second Address | Grand Rapids, MI 49525-5807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 01/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F57520 | (02) |