Provider Demographics
NPI:1063463818
Name:MELZER-LANGE, MARLENE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:D
Last Name:MELZER-LANGE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC EMERGENCY MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2647
Mailing Address - Fax:414-266-2635
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC EMERGENCY MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2647
Practice Address - Fax:414-266-2635
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI200412080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000126VOtherHUMANA
WI1063463818Medicaid
B85031Medicare UPIN
0048173601Medicare ID - Type Unspecified