Healthcare Provider Details

I. General information

NPI: 1275020331
Provider Name (Legal Business Name): MELANIE FAITH MCCORMICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 08/07/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST TOWER B STE 405
LINCOLN NE
68502-3793
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-5860
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36729
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: