MEDICARE: MELISSA JESSICA VICTOR 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	207Q00000X	Family Medicine Physician	4301113078	MI

General Provider Information

NPI Number	:	1386174308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JESSICA VICTOR MD

Provider Business Mailing Address
First Line	:	1447 N HARRISON ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-4727
Country	:	US
Telephone Number	:	989-583-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3875 BAY RD STE 2N
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-2423
Country	:	US
Telephone Number	:	989-583-5300
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	07/01/2020

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