Individual
MATTHEW J. MELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11725 N ILLINOIS ST, STE 558, CARMEL, IN 46032-3009
(317) 688-5500
(317) 688-5511
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01062033A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000771860
ANTHEM PIN
IN
05
—
201066530
—
IN
Enumeration date
05/21/2008
Last updated
12/17/2020
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