Provider Demographics
NPI:1538690318
Name:JAMES, MELISSA J (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1640 W LAKE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-9917
Mailing Address - Country:US
Mailing Address - Phone:630-543-3020
Mailing Address - Fax:630-543-1551
Practice Address - Street 1:1640 W LAKE ST FL 2
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-9917
Practice Address - Country:US
Practice Address - Phone:630-543-3020
Practice Address - Fax:630-543-1551
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125070286208000000X
390200000X
IL036152588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program