Healthcare Provider Details

I. General information

NPI: 1871699603
Provider Name (Legal Business Name): MELISSA L. COX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA L. HARDIEK M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STAHLHUT DR
LINCOLN IL
62656-5059
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-735-9555
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-104728
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104728
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: