Provider Demographics
NPI:1962593905
Name:GREENWOOD, MELANIE ANNE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:GREENWOOD
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 1:2020 N TYLER RD
Mailing Address - Street 2:STE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4916
Mailing Address - Country:US
Mailing Address - Phone:316-729-9100
Mailing Address - Fax:316-729-0407
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:STE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4916
Practice Address - Country:US
Practice Address - Phone:316-729-9100
Practice Address - Fax:316-729-0407
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4-22809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052026GRMedicare ID - Type Unspecified
KSE49899Medicare UPIN