Organization
THOMAS J. MELHAM, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J MELHAM MD (OWNER)
(765) 287-8596
Entity
Organization
Contact information
Practice address
2810 W ETHEL AVE STE 5, MUNCIE, IN 47304-4402
(765) 287-8596
(765) 287-8593
Mailing address
2810 W ETHEL AVE STE 5, MUNCIE, IN 47304-4402
(765) 287-8596
(765) 287-8593
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
01039790A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337600
BLUE CROSS ANTHEM
IN
01
—
10784368
CAQH
IN
01
—
1851495394
NPI PROVIDER
IN
01
—
5646042
AETNA
IN
Enumeration date
07/06/2007
Last updated
08/22/2020
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