Provider Demographics
NPI:1407918444
Name:MURN, MELANIE CLARE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:CLARE
Last Name:MURN
Suffix:
Gender:F
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387
Mailing Address - Country:US
Mailing Address - Phone:952-934-3296
Mailing Address - Fax:952-906-1737
Practice Address - Street 1:470 W 78TH ST
Practice Address - Street 2:STE 250
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-934-3296
Practice Address - Fax:952-906-1737
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28056202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0114847OtherMEDICA
MN0114847OtherMEDICA
A94825Medicare UPIN