Provider Demographics
NPI:1992906424
Name:KOUNINE, MELISSA M (DO)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:KOUNINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6485 SW BORLAND RD STE B
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9762
Mailing Address - Country:US
Mailing Address - Phone:503-609-0443
Mailing Address - Fax:800-858-8657
Practice Address - Street 1:6485 SW BORLAND RD STE B
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-609-0443
Practice Address - Fax:800-858-8657
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9147207X00000X
WAOP60182630207X00000X
ORDO152955207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOP60182630OtherWA STATE
OH34009147OtherOHIO LICENSE
ORDO152955OtherOR STATE