Basic Information
| Provider Information | |||||||||
| NPI: | 1710053616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNNICUTT | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | WAITT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 775383 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606775383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123765315 | ||||||||
| FaxNumber: | 8123753477 | ||||||||
| Practice Location | |||||||||
| Address1: | 2325 18TH ST | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123792020 | ||||||||
| FaxNumber: | 8123788267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 01041284A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 011274P | 01 | IN | SIHO | OTHER | 000000984929 | 01 | IN | ANTHEM PIN | OTHER | 100343040 | 05 | IN | MEDICAID | 64879596 | 01 | KY | KENTUCKY MEDICAID | OTHER | P01632091 | 01 | IN | MEDICARE RAIL ROAD | OTHER |