MEDICARE: MELANIE RAJKUMAR 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
1	207P00000X	Emergency Medicine Physician	MD477565	PA
2	207Q00000X	Family Medicine Physician	R-9626	IA
3	207P00000X	Emergency Medicine Physician	01078213	IN

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

General Provider Information

NPI Number	:	1962847434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE RAJKUMAR M.D.

Provider Business Mailing Address
First Line	:	3926 NEW VISION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1712
Country	:	US
Telephone Number	:	260-266-8210
Fax Number	:	260-458-5636

Provider Business Practice Location Address
First Line	:	101 S TAYLOR AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-2849
Country	:	US
Telephone Number	:	641-428-7766
Fax Number	:	641-428-7788

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	12/04/2023

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