Individual
MELANIE B ILLICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5010 LAKELAND CIRCLE, SUITE B, WACO, TX 76710-2981
(254) 776-3486
(254) 776-8466
Mailing address
5010 LAKELAND CIRCLE, SUITE B, WACO, TX 76710-2981
(254) 776-3486
(254) 776-8466
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J2104
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00291G
BCBS
TX
05
—
113408204
—
TX
01
—
G08042
UPIN
TX
Enumeration date
10/18/2007
Last updated
01/03/2021
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