Provider Demographics
NPI:1194024315
Name:KOUNS, MELISSA MAE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAE
Last Name:KOUNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MAE
Other - Last Name:LINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-4688
Mailing Address - Fax:859-301-2607
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-4688
Practice Address - Fax:859-301-2607
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059163207R00000X, 208000000X
SC38072207R00000X
OH35135424207R00000X
KY56775207RH0002X
IN01094388A207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC380723Medicaid
SCSC62909223Medicare UPIN