# MELICIEN TETTAMBEL, D.O., S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912028861
- **Authorized official:** DR. MELICIEN TETTAMBEL D.O. (PHYSICIAN)
- **Authorized official phone:** (660) 627-5175

## Contact information

- **Practice address:** 1108 E PATTERSON ST, SUITE 3, KIRKSVILLE, MO 63501-4002
- **Practice address phone:** (660) 627-5175
- **Practice address fax:** (660) 627-5180
- **Mailing address:** 1108 E PATTERSON ST, SUITE 3, KIRKSVILLE, MO 63501-4002
- **Mailing address phone:** (660) 627-5175
- **Mailing address fax:** (660) 627-5180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | R9714 | MO | — |
| 207V00000X | Obstetrics & Gynecology Physician | R9714 | MO | Yes |

## Other

- **Enumeration date:** 04/02/2007
- **Last updated:** 09/11/2025