Provider Demographics
NPI:1912311200
Name:BUSEY, MELISSA JANE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:BUSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6570
Mailing Address - Country:US
Mailing Address - Phone:405-615-8823
Mailing Address - Fax:
Practice Address - Street 1:4140 W MEMORIAL RD STE 413
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-755-2230
Practice Address - Fax:405-755-0389
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics