Individual
GREGORY MELLINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 PROVIDENT DR, SUITE A, WARSAW, IN 46580-3291
(574) 372-5823
Mailing address
1500 PROVIDENT DR, SUITE A, WARSAW, IN 46580-3291
(574) 372-5823
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
99027179A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000592337
ANTHEM
—
Enumeration date
07/27/2007
Last updated
01/15/2008
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