Provider Demographics
NPI:1225080666
Name:MARILIM, MEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:G
Last Name:MARILIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33241207Q00000X
IL036-088251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11431OtherWELLMARK BC/BS
049102OtherHEALTH ALLIANCE
IA0201806Medicaid
IL09822166OtherBLUE CROSS / BLUE SHIELD
IA0178OtherJOHN DEERE HEALTH
147067OtherIOWA HEALTH SOLUTIONS
19345OtherMIDLANDS CHOICE
IL036088251Medicaid
IL036088251Medicaid
IA11431OtherWELLMARK BC/BS
IA0178OtherJOHN DEERE HEALTH
F04017Medicare UPIN