Provider Demographics
NPI:1740170794
Name:MELIUS, ADAM VICTOR (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:VICTOR
Last Name:MELIUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860879
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0879
Mailing Address - Country:US
Mailing Address - Phone:402-483-3333
Mailing Address - Fax:
Practice Address - Street 1:1600 S 48TH ST STE 600
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1275
Practice Address - Country:US
Practice Address - Phone:402-560-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3293363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant