Provider Demographics
NPI:1750511242
Name:KIEL, MELISSA SCHLEEPER (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SCHLEEPER
Last Name:KIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:SCHLEEPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2019
Mailing Address - Country:US
Mailing Address - Phone:618-234-1774
Mailing Address - Fax:618-234-7979
Practice Address - Street 1:3990 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1919
Practice Address - Country:US
Practice Address - Phone:618-277-1130
Practice Address - Fax:618-277-4917
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL554480OtherMEDICARE GROUP
IL554490OtherMEDICARE GROUP