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General NPI Number Information
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NPI Number | 1871579565
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Entity Type | Individual
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Provider Name | MELINDA SUE HINTERMEISTER DO
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-364-4200
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Fax | 616-364-7347
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Provider Business Mailing Address
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Address Line | 3333 EVERGREEN DR NE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9493
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Country | US
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Telephone | 616-364-4200
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Fax | 616-364-7347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 03617
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02006416A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5101014927
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036110981
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License Number State | IL
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