Provider Demographics
NPI:1528053444
Name:THOMAS, MELINDA (PAC)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:731 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1225
Mailing Address - Country:US
Mailing Address - Phone:608-776-4497
Mailing Address - Fax:608-776-2317
Practice Address - Street 1:731 CLAY ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1225
Practice Address - Country:US
Practice Address - Phone:608-776-4497
Practice Address - Fax:608-776-2317
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1185-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42991500Medicaid
WI27070-0007Medicare ID - Type Unspecified
WI42991500Medicaid