Basic Information
| Provider Information | |||||||||
| NPI: | 1902004872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HICKEY | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52500 FIR RD | ||||||||
| Address2: | |||||||||
| City: | GRANGER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465308579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742710700 | ||||||||
| FaxNumber: | 5742735648 | ||||||||
| Practice Location | |||||||||
| Address1: | 52500 FIR RD | ||||||||
| Address2: | |||||||||
| City: | GRANGER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465308579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742710700 | ||||||||
| FaxNumber: | 5742735648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 08/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01068352A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.