Provider Demographics
NPI:1336117878
Name:MELODY, THERESA F (DPM)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:F
Last Name:MELODY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:11560 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3527
Practice Address - Country:US
Practice Address - Phone:513-851-7700
Practice Address - Fax:513-851-1046
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300942213E00000X
OH36003136213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2682762Medicaid
OHU81395Medicare UPIN
OH2682762Medicaid
0698420012Medicare NSC
P00347663Medicare PIN
OH4032304Medicare PIN