Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 5101014118 | MI |
NPI | 1013901610 |
---|---|
Provider Name | Vickie B Mello |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1652512154 | BLUE CROSS BLUE SHIELD MI (01) | MI |
3300266 | (05) | TN |
4085255 | BL CROSS (01) | TN |
I05563 | (02) | |
OB56025 | BCBSM GROUP (01) | MI |
OB56025 | MEDICARE GROUP (01) | MI |