Provider Demographics
NPI:1740267780
Name:TREVINO, MELANIE K (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:K
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUTIE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:12805 W BURLEIGH ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3156
Practice Address - Country:US
Practice Address - Phone:262-797-6434
Practice Address - Fax:262-797-6429
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-05-01
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Provider Licenses
StateLicense IDTaxonomies
WV40723207N00000X
WI40723207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11-00572OtherMEDICA
WI070013910Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN11-00572OtherMEDICA