Provider Demographics
NPI:1629142658
Name:MELNIK, MARIANNE K (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:MELNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6333
Mailing Address - Fax:616-486-6399
Practice Address - Street 1:145 MICHIGAN ST NE
Practice Address - Street 2:SUITE 4400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2562
Practice Address - Country:US
Practice Address - Phone:616-486-6333
Practice Address - Fax:616-486-6399
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIML067619207RX0202X, 208600000X
MI43010676192086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104745617Medicaid
MIML067619OtherBCBS
MIML067619OtherBCBS
MIN90160003Medicare ID - Type Unspecified