Healthcare Provider Details

I. General information

NPI: 1720242217
Provider Name (Legal Business Name): MICHELLE ANN MELLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W WASHINGTON ST
SHELBYVILLE IN
46176-1236
US

IV. Provider business mailing address

150 W WASHINGTON ST
SHELBYVILLE IN
46176-1236
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-5299
  • Fax:
Mailing address:
  • Phone: 317-398-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01065948
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: