Provider Demographics
NPI:1851631287
Name:KALTAK, MELINA C (DO)
Entity Type:Individual
Prefix:DR
First Name:MELINA
Middle Name:C
Last Name:KALTAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:CUSTOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:25080 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1740
Mailing Address - Country:US
Mailing Address - Phone:313-730-8880
Mailing Address - Fax:313-730-1167
Practice Address - Street 1:25080 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1740
Practice Address - Country:US
Practice Address - Phone:313-730-8880
Practice Address - Fax:313-730-1167
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025391207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology