Healthcare Provider Details

I. General information

NPI: 1659488054
Provider Name (Legal Business Name): MELODY CALLA REED PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY CALLA

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE DEPARTMENT OF NEUROLOGY
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

1309 WENONAH AVE
BERWYN IL
60402-1243
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2570
  • Fax: 847-570-2073
Mailing address:
  • Phone: 630-484-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-002754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: