Provider Demographics
NPI:1003258948
Name:MELISSA R KINDER MD, LLC
Entity Type:Organization
Organization Name:MELISSA R KINDER MD, LLC
Other - Org Name:HAND AND RECONSTRUCTIVE SURGERY NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-498-8190
Mailing Address - Street 1:10121 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5754
Mailing Address - Country:US
Mailing Address - Phone:503-498-8190
Mailing Address - Fax:503-305-7425
Practice Address - Street 1:10121 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 235
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5754
Practice Address - Country:US
Practice Address - Phone:503-498-8190
Practice Address - Fax:503-305-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161983208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500656021Medicaid