Healthcare Provider Details

I. General information

NPI: 1962098087
Provider Name (Legal Business Name): MELISSA MAE TUMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 ST FRANCIS DR STE 320
CROWN POINT IN
46307-0264
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-0077
  • Fax: 219-662-9496
Mailing address:
  • Phone: 131-752-8480
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: