Provider Demographics
NPI:1447242771
Name:MELLEM, MANEEB NMN (MD)
Entity Type:Individual
Prefix:DR
First Name:MANEEB
Middle Name:NMN
Last Name:MELLEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 N HIGHLAND AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5601
Mailing Address - Country:US
Mailing Address - Phone:903-892-8112
Mailing Address - Fax:903-893-8637
Practice Address - Street 1:600 N HIGHLAND AVE
Practice Address - Street 2:STE 101
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5601
Practice Address - Country:US
Practice Address - Phone:903-892-8112
Practice Address - Fax:903-893-8637
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG1953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00041364OtherRAILROAD MEDICARE
TX100037403Medicaid
C19275Medicare UPIN
TX100037403Medicaid