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NPI Code Detail

MEDICARE: DR. MELODY ANN GONGWER M.D.

MEDICARE: DR. MELODY ANN GONGWER M.D.
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
12084P0800XPsychiatry Physician01051287AIN
22084P0804XChild & Adolescent Psychiatry Physician01051287AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000192710OTHERANTHEM PIN

General Provider Information

NPI Number : 1194703009
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELODY ANN GONGWER M.D.
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2259
Provider Business Practice Location Address
First Line : 1315 HILLCREST RD
Second Line :
City : BEDFORD
State : IN
Zip : 47421-3023
Country : US
Telephone Number : 812-279-3591
Fax Number : 812-275-0787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 04/30/2009

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