Healthcare Provider Details

I. General information

NPI: 1467462812
Provider Name (Legal Business Name): MELISSA HAGUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/04/2022
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N GROVE ST
WICHITA KS
67214-4520
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-2415
  • Fax: 316-264-4734
Mailing address:
  • Phone: 316-858-7100
  • Fax: 316-858-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-32001
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: