Provider Demographics
NPI:1356066336
Name:DUERSON, MELIKA
Entity type:Individual
Prefix:MRS
First Name:MELIKA
Middle Name:
Last Name:DUERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 RADBURN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2644
Mailing Address - Country:US
Mailing Address - Phone:317-954-7409
Mailing Address - Fax:317-978-6729
Practice Address - Street 1:629 RADBURN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2644
Practice Address - Country:US
Practice Address - Phone:317-954-7409
Practice Address - Fax:317-978-6729
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2400-80-3406172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver