| Doctor Name: | MRS. MELISSA M ILG |
| NPI Number: | 1225083371 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 209005803 |
| Business Practice Address: | 921 N Lake Shore Dr Culver, IN - 465111207 |
| Business Phone Number: | 5743357780 |
| Business Fax Number: | 5743350730 |
| Mailing Address: | Po Box 6309, SOUTH BEND |
| State: | IN |
| Postal Code: | 466606309 |
| Phone Number: | 5743358700 |
| Fax Number: | 5743350760 |
| NPI Enumeration Date: | 05/24/2006 |
| NPI Last Update Date: | 07/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209005803 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |