Provider Demographics
NPI:1700048931
Name:ALLEN, MELISSA LAURA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LAURA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E JEFFERSON AVE
Mailing Address - Street 2:523
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4233
Mailing Address - Country:US
Mailing Address - Phone:519-997-3001
Mailing Address - Fax:
Practice Address - Street 1:3430 E JEFFERSON AVE
Practice Address - Street 2:523
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4233
Practice Address - Country:US
Practice Address - Phone:519-997-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002294213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery