Healthcare Provider Details

I. General information

NPI: 1447546031
Provider Name (Legal Business Name): MELISSA D ZAHRT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E 13TH ST
WINAMAC IN
46996-1117
US

IV. Provider business mailing address

616 E 13TH ST PO BOX 279
WINAMAC IN
46996-1117
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-2194
  • Fax: 574-946-2196
Mailing address:
  • Phone: 574-946-2194
  • Fax: 574-946-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116023669
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01074499A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: