Provider Demographics
NPI:1932685435
Name:MICHELON, MELODY ANNE
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANNE
Last Name:MICHELON
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 1:41000 WOODWARD AVE
Mailing Address - Street 2:SUITE 100 EAST
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5130
Mailing Address - Country:US
Mailing Address - Phone:248-593-6990
Mailing Address - Fax:248-593-5925
Practice Address - Street 1:41000 WOODWARD AVE
Practice Address - Street 2:SUITE 100 EAST
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5130
Practice Address - Country:US
Practice Address - Phone:248-593-6990
Practice Address - Fax:248-593-5925
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282226363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health