Organization
MELANIE ILLICH MD PA
Active
Other names
Melanie Illich MD PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELANIE B ILLICH MD (PRESIDENT)
(254) 772-2006
Entity
Organization
Contact information
Practice address
213A OLD HEWITT RD, WACO, TX 76712
(254) 772-2006
(254) 772-2011
Mailing address
PO BOX 23289, WACO, TX 76702
(254) 772-2006
(254) 772-2011
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J2104
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113408204
—
TX
05
—
157845201
—
TX
Enumeration date
09/12/2006
Last updated
11/26/2013
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