Provider Demographics
NPI:1437125119
Name:MELANSON, TINA M (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MELANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 9TH NWAVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1548
Mailing Address - Country:US
Mailing Address - Phone:605-882-5455
Mailing Address - Fax:
Practice Address - Street 1:1001 E 21ST ST
Practice Address - Street 2:STE. 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1033
Practice Address - Country:US
Practice Address - Phone:605-322-5800
Practice Address - Fax:605-322-5801
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5105207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1706711OtherARAZ/ AMERICA'S PPO
SD6630830Medicaid
MN300T3MEOtherBLUE CROSS
IA0560631Medicaid
SD390008566OtherRR MEDICARE
SD0040703OtherBLUE CROSS
SD28925OtherSANFORD HEALTH PLAN
SD5105OtherDAKOTACARE
SDHP38411OtherHEALTHPARTNERS
ND12903Medicaid
SD237914OtherMIDLANDS CHOICE
SD406751032068OtherPREFERRED ONE
NE46022474344Medicaid
MN300T3MEOtherCC SYSTEMS/ BLUE PLUS
SD3100148OtherMEDICA
SD57105P005OtherWPS TRICARE
MN891490700Medicaid
MN300T3MEOtherCC SYSTEMS/ BLUE PLUS
SD390008566OtherRR MEDICARE
SDH73818Medicare UPIN