Provider Demographics
NPI:1962582254
Name:FOGELMAN REDLEAF, MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:FOGELMAN REDLEAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:REDLEAF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4848 E CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4163
Mailing Address - Country:US
Mailing Address - Phone:602-996-0190
Mailing Address - Fax:602-971-3122
Practice Address - Street 1:4848 E CACTUS RD STE 620
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4109
Practice Address - Country:US
Practice Address - Phone:602-996-0190
Practice Address - Fax:602-996-5516
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22255208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184151Medicaid
AZ184151Medicaid