Melanie Illich Md Pa | |
213a Old Hewitt Rd Waco TX 76712 | |
(254) 772-2006 | |
(254) 772-2011 |
Full Name | Melanie Illich Md Pa |
---|---|
Speciality | Psychiatry & Neurology - Psychiatry |
Location | 213a Old Hewitt Rd, Waco, Texas |
Authorized Official Name and Position | Melanie B Illich (PRESIDENT) |
Authorized Official Contact | 2547722006 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Melanie Illich Md Pa Po Box 23289 Waco TX 76702 Ph: (254) 772-2006 | Melanie Illich Md Pa 213a Old Hewitt Rd Waco TX 76712 Ph: (254) 772-2006 |
NPI Number | 1699879288 |
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Provider Enumeration Date | 09/12/2006 |
Last Update Date | 11/26/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699879288 | NPI | - | NPPES |
113408204 | Medicaid | TX | |
157845201 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | J2104 (Texas) | Primary |
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