Provider Demographics
NPI:1023376209
Name:MELICHAR, PAUL JAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAN
Last Name:MELICHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1349
Mailing Address - Country:US
Mailing Address - Phone:952-941-3136
Mailing Address - Fax:
Practice Address - Street 1:5512 BROOK DRIVE
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-1349
Practice Address - Country:US
Practice Address - Phone:952-941-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18.4582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry