Individual provider Active NPI

Michelle Annette Melyn, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • River Forest, IL
National Provider Identifier
1457484669
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
Practice address
7777 West Lake St
River Forest, IL 60305
Phone
(708) 366-1022
Fax
(708) 366-1906
NPI assigned
Mar 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X IL Primary

Addresses

Primary practice location

7777 West Lake St
River Forest, IL 60305

Mailing address

807 Ashland Avenue
River Forest, IL 60305
Phone (708) 366-6482

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-040735ILMDNeurology with Special Qualifications in Child Neurology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457484669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 ASHLAND AVENUE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "60305",
            "telephone_number": "708-366-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 WEST LAKE ST",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "60305",
            "telephone_number": "708-366-1022",
            "fax_number": "708-366-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELYN",
        "first_name": "MICHELLE",
        "middle_name": "ANNETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in River Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.