Provider Demographics
NPI:1144215146
Name:GOODELL, MELANIE E (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:GOODELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-615-0700
Mailing Address - Fax:847-615-1708
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-615-0700
Practice Address - Fax:847-615-1708
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics