Provider Demographics
NPI:1063692978
Name:MILLEWICH, MELISSA ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROSE
Last Name:MILLEWICH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:MERCY HOSPITAL & MEDICAL CENTER - DEPT OF EMERGENCY MED
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-945-0646
Mailing Address - Fax:
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:MERCY HOSPITAL & MEDICAL CENTER - DEPT OF EMERGENCY MED
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.126140207P00000X
OH34.009408207P00000X
WI54288-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine