Provider Demographics
NPI:1871579565
Name:HINTERMEISTER, MELINDA SUE (DO)
Entity type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:SUE
Last Name:HINTERMEISTER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3333 EVERGREEN DR NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9493
Mailing Address - Country:US
Mailing Address - Phone:616-364-4200
Mailing Address - Fax:616-364-7347
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-364-4200
Practice Address - Fax:616-364-7347
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA03617207L00000X
IN02006416A207L00000X
MI5101014927207L00000X
IL036110981207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871579565Medicaid
IA0463869Medicaid
IN300063902Medicaid
IN264430G93OtherMEDICARE