Provider Demographics
NPI:1023339603
Name:ANDREWS, MELANIE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ANDREWS
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 1:5901 N PROSPECT RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1395
Mailing Address - Country:US
Mailing Address - Phone:309-740-4232
Mailing Address - Fax:
Practice Address - Street 1:5901 N PROSPECT RD STE 101B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1395
Practice Address - Country:US
Practice Address - Phone:309-740-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130995207Q00000X
MA254621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130995OtherLICENSE