Provider Demographics
NPI:1336702216
Name:MCMELLEN, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:MCMELLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23550 PARK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2592
Mailing Address - Country:US
Mailing Address - Phone:313-730-0500
Mailing Address - Fax:313-730-0606
Practice Address - Street 1:23550 PARK ST STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2592
Practice Address - Country:US
Practice Address - Phone:313-730-0500
Practice Address - Fax:313-730-0606
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301514122207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery