Provider Demographics
NPI:1053452425
Name:TREKELL, MELISSA EMLYN (MD,FACS,MBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:EMLYN
Last Name:TREKELL
Suffix:
Gender:F
Credentials:MD,FACS,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:250 BMH PHYSICIANS OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5904
Practice Address - Country:US
Practice Address - Phone:865-980-5244
Practice Address - Fax:865-980-5245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3019830Medicaid
621278569OtherFEIN
TN2002792OtherBLUE CROSS & BLUE SHIELD
TN2002792OtherBLUE CROSS & BLUE SHIELD