Provider Demographics
NPI:1770788663
Name:HAYES, MELANIE BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:BROOKE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:BROOKE
Other - Last Name:GATEWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4468 THICKET TRCE
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9687
Mailing Address - Country:US
Mailing Address - Phone:317-490-4033
Mailing Address - Fax:317-782-4301
Practice Address - Street 1:5550 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1991
Practice Address - Country:US
Practice Address - Phone:317-534-4660
Practice Address - Fax:317-782-4301
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068936A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201028870Medicaid
KS000000730633OtherBCBS