Provider Demographics
NPI:1538620661
Name:MEJIA BAUTISTA, MELISSA ALEJANDRA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALEJANDRA
Last Name:MEJIA BAUTISTA
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:RESIDENCIAL QUINTAS CALIFORNIA
Mailing Address - Street 2:BLOCK C,#2,CARRETERA A ACAJUTLA
Mailing Address - City:SONSONATE
Mailing Address - State:SONSONATE
Mailing Address - Zip Code:00000
Mailing Address - Country:SV
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073979207ZP0102X
390200000X
IL036.159362207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program