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Individual

DAWN MELLISH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036137255
IL
207R00000X
Internal Medicine Physician
176023
NY

Other

Enumeration date
12/14/2005
Last updated
02/09/2015
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