Provider Demographics
NPI:1588677991
Name:ALTOM, MELISSA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:C
Last Name:ALTOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:106 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-6260
Practice Address - Country:US
Practice Address - Phone:417-269-2400
Practice Address - Fax:417-269-2410
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112771207Q00000X
ARE5435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204965602Medicaid
MO204965602Medicaid
128131OtherBLUE CROSS MO
080158091Medicare PIN
H14918Medicare UPIN