MEDICARE: ALLISON DAISY MELTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.031366	IL

General Provider Information

NPI Number	:	1053112623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON DAISY MELTON

Provider Business Mailing Address
First Line	:	111 E CHESTNUT ST APT 25H
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-6003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N MAY ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-6495
Country	:	US
Telephone Number	:	847-660-3057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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Directions to “ ALLISON DAISY MELTON ” Practice Location

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