Provider Demographics
NPI:1346633120
Name:VAN CAIN, MELISSA SARAH (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SARAH
Last Name:VAN CAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SARAH
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 CHILDRENS AVE STE 11200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-397-6709
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 6A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-6827
Practice Address - Fax:405-271-4418
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA270029208000000X
390200000X
OK34838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program