MEDICARE: MELISSA F HALVORSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MH070380	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0770053	OTHER	MI	PHP FAMILYCARE PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1016279	OTHER	MI	MCLAREN PROVIDER #
4	0331169	OTHER	MI	BCBS/BCN PROVIDER #
5	0700378	OTHER	MI	PHP PROVIDER #

General Provider Information

NPI Number	:	1114994365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA F HALVORSON MD

Provider Business Mailing Address
First Line	:	1560 TURF LANE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6392
Country	:	US
Telephone Number	:	517-484-3000
Fax Number	:	517-484-6358

Provider Business Practice Location Address
First Line	:	1005 S US HIGHWAY 27 STE 100
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2423
Country	:	US
Telephone Number	:	989-224-3000
Fax Number	:	989-668-0423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	01/20/2023

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Directions to “ MELISSA F HALVORSON MD” Practice Location

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