Provider Demographics
NPI:1932288586
Name:MURPHY, MELVIN C (MD)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:C
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 485
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-552-9050
Mailing Address - Fax:248-552-1290
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 485
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-552-9050
Practice Address - Fax:248-552-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMM041189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106301202OtherBLUE CROSS BLUE SHIELD
MI2106760Medicaid
MI2106760Medicaid
P48650001Medicare PIN
MI0630120Medicare ID - Type Unspecified