Individual
B THEO MELLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D, M.D.
Contact information
Practice address
3223 N WEBB RD, SUITE 1, WICHITA, KS 67226-8175
(316) 609-2600
(206) 609-2800
Mailing address
3223 N WEBB RD, SUITE 1, WICHITA, KS 67226-8175
(316) 609-2600
(206) 609-2800
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
0430952
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200270470B
—
KS
Enumeration date
06/24/2006
Last updated
01/31/2017
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