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General NPI Number Information
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NPI Number | 1912028861
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Entity Type | Organization
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Legal Business Name | MELICIEN TETTAMBEL, D.O., S.C.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1108 E PATTERSON ST SUITE 3
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4002
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Country | US
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Telephone | 660-627-5175
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Fax | 660-627-5180
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Provider Business Mailing Address
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Address Line | 1108 E PATTERSON ST SUITE 3
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4002
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Country | US
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Telephone | 660-627-5175
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Fax | 660-627-5180
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MELICIEN TETTAMBEL
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Credential | D.O.
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Telephone | 660-627-5175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | R9714
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | R9714
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License Number State | MO
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