Healthcare Provider Details

I. General information

NPI: 1083908602
Provider Name (Legal Business Name): MELISSA O'RYAN MEKESA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY PARK DR
MARION OH
43302-6399
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-8700
  • Fax: 937-619-4150
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-121848
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME149190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: