Provider Demographics
NPI:1639297443
Name:MELICOR, REBECCA V (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:V
Last Name:MELICOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DRIVE
Mailing Address - Street 2:SUITE 1200 WEST TOWER
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:
Practice Address - Street 1:627 E. MAPLE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2812
Practice Address - Country:US
Practice Address - Phone:615-778-4066
Practice Address - Fax:615-778-9114
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010391552083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1504006Medicare UPIN
MIMI1504Medicare PIN
MIMI1503Medicare PIN
MIOP46120Medicare PIN
MIMI1503006Medicare UPIN
MIP46120003Medicare UPIN