Melanie Ann Mailloux, MD

Key facts

NPI

1780647263

Entity type

Individual (NPI type 1)

Primary specialty

Pediatrics Physician 208000000X

License

53698-20 (WI)

Practice address

5433 W Fond Du Lac Ave
Milwaukee, WI 53216-1382

Phone

(414) 277-8900

Fax

(414) 277-8939

NPI assigned

Apr 7, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Medical Group Pediatrics Physician · Glendale, WI · NPI 1134394471
  NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mmailloux8322@direct.chw.org

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 15, 2016.

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1780647263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5433 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532161382",
            "telephone_number": "414-277-8900",
            "fax_number": "414-277-8939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAILLOUX",
        "first_name": "MELANIE",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101231620",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "53698-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903026",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010217504",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780647263",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

• Jonathan Mai, DDS
• Diana Jean Maier, RD
• Andrew S Maike, M.D.
• Danielle Ashley Maila, PHARMD
• Claire Maillefer
• Dennis J Maiman, MD
• Philip Jeffrey Maio, OTR/L
• Jenna Marie Maiorelle, APRN-NP
• Karen A Maisonet
• Ceceleta Yvonne Maitland, MD

All providers in Milwaukee, WI · Pediatrics Physician in Wisconsin