Provider Demographics
NPI:1437393535
Name:MILLER, MELINDA KAY (MD)
Entity Type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:KAY
Last Name:MILLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE
Practice Address - Street 2:SUITE 4400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2562
Practice Address - Country:US
Practice Address - Phone:616-486-6333
Practice Address - Fax:616-486-6399
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2021-02-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301039611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437393535Medicaid
MIM74460855Medicare PIN