Provider Demographics
NPI:1083704753
Name:PESSIN, MELISSA S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:PESSIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:S
Other - Last Name:PESSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1443
Mailing Address - Country:US
Mailing Address - Phone:773-795-4866
Mailing Address - Fax:773-702-9082
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-795-4866
Practice Address - Fax:773-702-9082
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193483207ZB0001X, 207ZP0105X
IL036.159640207ZB0001X, 207ZC0008X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05042Medicare UPIN
812571Medicare PIN