Individual
MELANIE CUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
611 VETERANS AVE UNIT 106, WEST BEND, WI 53090-2559
(262) 353-4460
(262) 353-4461
Mailing address
103 FINANCIAL PL, SUITE 100, ELIZABETHTOWN, KY 42701-4470
(270) 769-0110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
70643-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053686493
—
WI
Enumeration date
03/19/2012
Last updated
02/09/2021
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