Provider Demographics
NPI:1417362039
Name:GATES, MELISSA KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAY
Last Name:GATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:KAY HART
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1174 W MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1625
Mailing Address - Country:US
Mailing Address - Phone:269-558-0700
Mailing Address - Fax:269-558-0701
Practice Address - Street 1:1174 W MICHIGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1625
Practice Address - Country:US
Practice Address - Phone:269-558-0700
Practice Address - Fax:269-558-0701
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine