Healthcare Provider Details

I. General information

NPI: 1063486157
Provider Name (Legal Business Name): MELPOMENI G KAVADELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRANKFORT HWY SUITE #200
BENZONIA MI
49616-9558
US

IV. Provider business mailing address

9310 EVERGREEN DR
TRAVERSE CITY MI
49684-7822
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-2168
  • Fax:
Mailing address:
  • Phone: 231-935-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: