1134694813 NPI number — MELANIE DAWN MONTEITH RD, CD

Table of content: MELANIE DAWN MONTEITH RD, CD (NPI 1134694813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134694813 NPI number — MELANIE DAWN MONTEITH RD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTEITH
Provider First Name:
MELANIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STURM
Provider Other First Name:
MELANIE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD,CD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134694813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 ESKENAZI AVE
Provider Second Line Business Mailing Address:
FIFTH THIRD BANK BLDG, 5TH FL
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-4166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-880-4121
Provider Business Mailing Address Fax Number:
317-880-4121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 ESKENAZI AVE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-880-7000
Provider Business Practice Location Address Fax Number:
317-880-0526
Provider Enumeration Date:
10/09/2018

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: 133V00000X , with the licence number:  37002968A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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