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Individual

GARY A. MELLICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2525 W UNIVERSITY AVE STE 502, MUNCIE, IN 47303-3409
(765) 751-2600
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
055142
GA
174400000X
Specialist
34004503
OH
2084N0400X
Neurology Physician
Primary
02006613A
IN
2084N0400X
Neurology Physician
DO1117
AL
2084N0600X
Clinical Neurophysiology Physician
DO1117
AL
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
DO1117
AL
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
DO1117
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
078521
OH
Enumeration date
04/26/2006
Last updated
01/14/2022
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