Basic Information
| Provider Information | |||||||||
| NPI: | 1043257348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 752 N HIGH POINT RD | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537172236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088244800 | ||||||||
| FaxNumber: | 6088244910 | ||||||||
| Practice Location | |||||||||
| Address1: | 752 N HIGH POINT RD | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537172236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088244800 | ||||||||
| FaxNumber: | 6088244910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 45902-020 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1043257348 | 05 | WI | MEDICAID | 60241 | 01 | WI | DEAN HEALTH INSURANCE | OTHER | 34458500 | 05 | WI | MEDICAID |