Healthcare Provider Details

I. General information

NPI: 1639157688
Provider Name (Legal Business Name): MELANIE ELIZABETH JUNGBLUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S MAIN ST STE 5
CELINA OH
45822-2467
US

IV. Provider business mailing address

830 W MAIN ST
COLDWATER OH
45828-1626
US

V. Phone/Fax

Practice location:
  • Phone: 567-890-7163
  • Fax: 567-890-7193
Mailing address:
  • Phone: 567-890-7143
  • Fax: 419-586-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35062650J
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: