Provider Demographics
NPI:1619517620
Name:ARDIS, MELISA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:ANN
Last Name:ARDIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:ANN
Other - Last Name:BAZUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2480 ROSEWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-3823
Mailing Address - Fax:810-275-0307
Practice Address - Street 1:2480 ROSEWOOD N
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-3823
Practice Address - Fax:989-773-5061
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009834APP20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine