Mellema, Jonathan W

Mellema, Jonathan W is an individual health care provider with primary practice located at 1801 19Th Ave Sw , Willmar MN 56201-4946. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Mellema, Jonathan W can be contacted via phone (320) 231-3277.

Contact Information

Primary practice address
1801 19Th Ave Sw Willmar MN 56201-4946
Phone: (320) 231-3277
Fax: (320) 214-5758
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 47540 Minnesota
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 11483 South Dakota

Profile Details

NPI number 1083680458
LBN Legal business name Mellema, Jonathan W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2006
Last updated Jun 22nd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083680458 NPPES
Minnesota MEDICAID 312128300

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