Provider Demographics
NPI:1598751968
Name:HILDEBRANDT, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:HILDEBRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-9592
Mailing Address - Country:US
Mailing Address - Phone:616-527-4281
Mailing Address - Fax:
Practice Address - Street 1:330 LOVELL ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9706
Practice Address - Country:US
Practice Address - Phone:616-527-5732
Practice Address - Fax:616-527-5720
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301G7296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803410401OtherBLUE CROSS BLUE SHIELD
MI0803410401OtherBLUE CROSS BLUE SHIELD
WI0340013Medicare ID - Type Unspecified
TN233882Medicare ID - Type Unspecified