Provider Demographics
NPI:1659370054
Name:COLBERN, MELISSA M (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:COLBERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:600 SW JEWELL AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1607
Practice Address - Country:US
Practice Address - Phone:785-295-5310
Practice Address - Fax:785-295-5370
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120938207Q00000X
AZ55633207Q00000X
TXS1789207Q00000X
PAMD467246207Q00000X
CAC160767207Q00000X
NY297261207Q00000X
UT10643560-1205207Q00000X
MN63229207Q00000X
COCDR.0000056207Q00000X
IL036.144848207Q00000X
NV17620207Q00000X
SD10717207Q00000X
MTMED-PHYS-LIC-61050207Q00000X
IAMD-44868207Q00000X
KS427643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH21169Medicare UPIN
KS103132Medicare ID - Type UnspecifiedMEDICARE