Provider Demographics
NPI:1417071226
Name:MULLINS, MELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:
Last Name:MULLINS
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 1:2222 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2673
Mailing Address - Country:US
Mailing Address - Phone:419-251-8210
Mailing Address - Fax:
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:SUITE 2800
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2675
Practice Address - Country:US
Practice Address - Phone:419-251-8210
Practice Address - Fax:419-251-7700
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010746622080P0207X
OH351261612080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0128251Medicaid
MI1417071226Medicaid
MI1417961137OtherBCBSM - BRONSON
MIC97618315 - BRONSONMedicare PIN