Individual
DR. MELODY ANN GONGWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1315 HILLCREST RD, BEDFORD, IN 47421-3023
(812) 279-3591
(812) 275-0787
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
(812) 337-2259
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01051287A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01051287A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000192710
ANTHEM PIN
—
05
—
200264440A
—
IN
Enumeration date
01/03/2006
Last updated
04/30/2009
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