Individual
MELANIE SUSAN SULISTIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
5323 HARRY HINES BOULEVARD, DALLAS, TX 75390-7201
(214) 645-7500
(214) 645-0078
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 645-7500
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M2135
TX
207RC0000X
Cardiovascular Disease Physician
Primary
M2135
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175964901
—
TX
Enumeration date
08/05/2006
Last updated
05/18/2015
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