1124219043 NPI number — DR. MELENA DAWN BELLIN MD

Table of content: DR. MELENA DAWN BELLIN MD (NPI 1124219043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124219043 NPI number — DR. MELENA DAWN BELLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLIN
Provider First Name:
MELENA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124219043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 RIVERSIDE AVE
Provider Second Line Business Mailing Address:
EAST BUILDING, ROOM MB671
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55454-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-624-5409
Provider Business Mailing Address Fax Number:
612-626-5262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-365-6777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  47172 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0205X , with the licence number: 47172 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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