NPIMap

Individual provider Active NPI

Melina C Kaltak, D.O.

  • Obstetrics & Gynecology Physician
  • Dearborn, MI
National Provider Identifier
1851631287
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5101025391 Issued in MI
Practice address
25080 Michigan Ave
Dearborn, MI 48124-1740
Phone
(313) 730-8880
Fax
(313) 730-1167
NPI assigned
Feb 21, 2013
Last updated
Nov 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5101025391 MI Primary

Addresses

Primary practice location

25080 Michigan Ave
Dearborn, MI 48124-1740

Mailing address

25080 Michigan Ave
Dearborn, MI 48124-1740
Phone (313) 730-8880

Other practice location 1

611 W Park St
Urbana, IL 61801-2529
Phone (217) 383-3140

Other names 1

  • Melina Custovic Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200627000192 MI Practitioner - Obstetrics/Gynecology 6103058136 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Michigan State University College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dearborn Obstetrical and Gynecological Associates, P.C.Group PAC ID 4880719715, 5 clinicians

Practice addresses (Care Compare)

25080 Michigan Ave
Dearborn, MI 48124-1740
Phone (313) 730-8880

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dearborn Obstetrical and Gynecological Associates, P.C. CurrentSince Jul 1, 2020 Accepting new patients
Beaumont Medical Group Hospital -Based Services CurrentSince Mar 14, 2021 Accepting new patients
Oakwood Healthcare, Inc. Past Accepting new patients

Locations

25080 Michigan Ave
Dearborn, MI 48124
Phone (313) 730-8880

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

Interoperability endpoints

  • Direct secure messaging: mkaltak1240722@epic00.shdirect.org

Organizations & group practices 3

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1851631287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25080 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241740",
            "telephone_number": "313-730-8880",
            "fax_number": "313-730-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25080 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241740",
            "telephone_number": "313-730-8880",
            "fax_number": "313-730-1167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 W Park St",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "618012529",
            "country_code": "US",
            "telephone_number": "217-383-3140",
            "fax_number": "217-383-4966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALTAK",
        "first_name": "MELINA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101025391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELINA",
            "last_name": "CUSTOVIC",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.