Provider Demographics
NPI:1568691483
Name:ANTOINE, MELISSA MACKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MACKLIN
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13930 SUMMERFAIR CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5997
Mailing Address - Country:US
Mailing Address - Phone:832-282-2071
Mailing Address - Fax:
Practice Address - Street 1:3811 LYONS AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-8306
Practice Address - Country:US
Practice Address - Phone:713-351-7360
Practice Address - Fax:713-351-7361
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP84052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid