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1386676039

NPI Code Detail

MEDICARE: MRS. MELISSA LEE PARK MD

MEDICARE: MRS. MELISSA LEE PARK 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	207R00000X	Internal Medicine Physician	015943	ME
2	207R00000X	Internal Medicine Physician	M-10546	ID

Other Identifiers

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

General Provider Information

NPI Number	:	1386676039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA LEE PARK MD

Provider Business Mailing Address
First Line	:	611 N IRON BRIDGE WAY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-4932
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 IDAHO ST
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-1940
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/22/2020

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Directions to “ MRS. MELISSA LEE PARK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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