MEDICARE: MELODY ANNE MICHELON

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	363LW0102X	Women's Health Nurse Practitioner	4704282226	MI

General Provider Information

NPI Number	:	1932685435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY ANNE MICHELON

Provider Business Mailing Address
First Line	:	41000 WOODWARD AVE
Second Line	:	SUITE 100 EAST
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5130
Country	:	US
Telephone Number	:	248-593-6990
Fax Number	:	248-593-5925

Provider Business Practice Location Address
First Line	:	41000 WOODWARD AVE
Second Line	:	SUITE 100 EAST
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5130
Country	:	US
Telephone Number	:	248-593-6990
Fax Number	:	248-593-5925

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

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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