Provider Demographics
NPI:1588084552
Name:WATTS, MELISSA (MD, MPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2330
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2915
Mailing Address - Country:US
Mailing Address - Phone:312-926-3674
Mailing Address - Fax:312-926-6905
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2330
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2915
Practice Address - Country:US
Practice Address - Phone:312-926-3674
Practice Address - Fax:312-926-6905
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036146476207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program