Provider Demographics
NPI:1578544789
Name:RICHARDSON, MELISSA SNYDER (DO)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SNYDER
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-4010
Mailing Address - Fax:517-913-4011
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-4010
Practice Address - Fax:517-913-4011
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012149208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002738OtherPHP
MIP00456401OtherRAILROAD MEDICARE
MI1020387OtherFIRST HEALTH
MI1020387OtherCURANET
MI1020387OtherMCLAREN HEALTH PLAN-MEDIC
MI1020387OtherHEALTH ADVANTAGE
MI0253301925OtherBLUE CROSS BLUE SHIELD
MI1020387OtherMCLAREN HEALTH PLAN-COMM.
MI4911182Medicaid
MI0M21440054OtherMEDICARE ADVANTAGE
MI200000002738OtherPHP FAMILYCARE
MI3497274Medicaid
MI0253301925OtherBLUE CARE NETWORK
MI3497274Medicaid
MI1020387OtherHEALTH ADVANTAGE