Individual
MELISSA D HUMMELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 882-2000
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 563-3699
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M1155
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0066MP
BCBS
TX
05
—
173465901
—
TX
Enumeration date
06/01/2006
Last updated
04/24/2013
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