Provider Demographics
NPI:1861418907
Name:ASGAONKAR, MELISSA D
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:ASGAONKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92005
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0101
Mailing Address - Country:US
Mailing Address - Phone:817-865-3564
Mailing Address - Fax:
Practice Address - Street 1:1130 N KIMBALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4732
Practice Address - Country:US
Practice Address - Phone:817-865-3564
Practice Address - Fax:817-865-3576
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics