MEDICARE: DR. MELISSA LYNN GILLIAM

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	207VG0400X	Gynecology Physician		IL

General Provider Information

NPI Number	:	1356443147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LYNN GILLIAM

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE # 2050
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6127
Fax Number	:	773-702-0840

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # 2050
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6127
Fax Number	:	773-702-0840

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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