Basic Information
| Provider Information | |||||||||
| NPI: | 1184715500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984545 | ||||||||
| FaxNumber: | 7652984945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984545 | ||||||||
| FaxNumber: | 7652984945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 03/13/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 01030401A | IN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000000086594 | 01 | IN | ANTHEM BLUE CROSS BLUE SH | OTHER |