Provider Demographics
NPI:1225083371
Name:ILG, MELISSA M (NP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:M
Last Name:ILG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8269
Mailing Address - Country:US
Mailing Address - Phone:574-772-4040
Mailing Address - Fax:
Practice Address - Street 1:1001 S EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8269
Practice Address - Country:US
Practice Address - Phone:574-772-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005407A363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000928256OtherBCBS SJHC
IN201284330Medicaid
IN000000924950OtherBCBS LSC
IN000000928877OtherBCBS PFIM
IN000000928643OtherBCBS MCFP
INM161595001Medicare PIN
IN000000928643OtherBCBS MCFP
Q65740Medicare UPIN
ININ1933018Medicare PIN
IN187610001Medicare PIN