Provider Demographics
NPI:1821040114
Name:LIVELY, MELANIE L (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:LIVELY
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 1:9051 N E 81ST TERR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158
Mailing Address - Country:US
Mailing Address - Phone:816-792-1170
Mailing Address - Fax:816-792-3877
Practice Address - Street 1:9051 N E 81ST TERR
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158
Practice Address - Country:US
Practice Address - Phone:816-792-1170
Practice Address - Fax:816-792-3877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO110708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics