Provider Demographics
NPI:1558687038
Name:XENIDIS, MELISSA ES (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ES
Last Name:XENIDIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:S
Other - Last Name:BLITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5801 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2397
Mailing Address - Country:US
Mailing Address - Phone:630-971-2645
Mailing Address - Fax:
Practice Address - Street 1:5801 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2397
Practice Address - Country:US
Practice Address - Phone:630-971-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135191208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation