Provider Demographics
NPI:1972134187
Name:GERGEL, MELISSA ANN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GERGEL
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4685
Mailing Address - Country:US
Mailing Address - Phone:708-226-2318
Mailing Address - Fax:708-226-2319
Practice Address - Street 1:15300 WEST AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4685
Practice Address - Country:US
Practice Address - Phone:708-226-2318
Practice Address - Fax:708-226-2319
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant