Provider Demographics
NPI:1023516572
Name:MELANIE KATIN
Entity type:Organization
Organization Name:MELANIE KATIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-449-5038
Mailing Address - Street 1:811 FOREST AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5524
Mailing Address - Country:US
Mailing Address - Phone:917-449-5038
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 701
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6031
Practice Address - Country:US
Practice Address - Phone:917-449-5038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001356171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty