Individual
MELODY A SHRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
103 W PIONEER AVE, VIBORG, SD 57070
(605) 326-5201
(605) 326-5196
Mailing address
103 W. PIONEER AVE., VIBORG, SD 57070
(605) 326-5201
(605) 326-5196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01071457A
IN
207Q00000X
Family Medicine Physician
Primary
12197
SD
207Q00000X
Family Medicine Physician
MD2013-0913
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201093130
—
IN
Enumeration date
06/14/2011
Last updated
11/06/2020
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