Provider Demographics
NPI:1184687063
Name:ROOKSTOOL, MELANY S (MD)
Entity type:Individual
Prefix:
First Name:MELANY
Middle Name:S
Last Name:ROOKSTOOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELANY
Other - Middle Name:S
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6005
Mailing Address - Street 2:DEPT 196
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6005
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-614-9641
Practice Address - Fax:317-614-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040513207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200056520Medicaid
IN000000711855OtherANTHEM
INP00936233OtherRRMEDICARE
IN000000711855OtherANTHEM
INP00936233OtherRRMEDICARE
IN810990Medicare PIN