Provider Demographics
NPI:1659488054
Name:CALLA REED, MELODY (PA-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:CALLA REED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:CALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 WENONAH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1243
Mailing Address - Country:US
Mailing Address - Phone:630-484-6620
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2570
Practice Address - Fax:847-570-2073
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002754363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK30019Medicare ID - Type Unspecified
ILQ71259Medicare UPIN