Provider Demographics
NPI:1114994365
Name:HALVORSON, MELISSA F (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 TURF LANE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6392
Mailing Address - Country:US
Mailing Address - Phone:517-484-3000
Mailing Address - Fax:517-484-6358
Practice Address - Street 1:1005 S US HIGHWAY 27 STE 100
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2423
Practice Address - Country:US
Practice Address - Phone:989-224-3000
Practice Address - Fax:989-668-0423
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH070380207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0770053OtherPHP FAMILYCARE PROVIDER #
MI4662800Medicaid
MI1016279OtherMCLAREN PROVIDER #
MI0331169OtherBCBS/BCN PROVIDER #
MI0700378OtherPHP PROVIDER #
MI1016279OtherMCLAREN PROVIDER #