Individual
MR. ALEXANDER MELNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2015 JACKSON ST, ANDERSON, IN 46016-4337
(765) 646-8439
Mailing address
2903 W JACKSON ST, MUNCIE, IN 47304-4307
(765) 741-1411
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
FM0844868
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340095
BLUE CROSS/BLUE SHIELD
IN
01
—
970024419
RAILROAD MEDICARE
IN
Enumeration date
07/21/2005
Last updated
05/12/2011
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