Healthcare Provider Details

I. General information

NPI: 1568922375
Provider Name (Legal Business Name): MELISSA JUNE WINKIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA JUNE WOLZ MD

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CLAIREDAN DR
POWELL OH
43065-8064
US

IV. Provider business mailing address

55 CLAIREDAN DR
POWELL OH
43065-8064
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-8989
  • Fax: 614-888-8968
Mailing address:
  • Phone: 614-888-8989
  • Fax: 614-888-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.148063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: