Provider Demographics
NPI:1629060165
Name:OPOLKA, CINDY (MD)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:OPOLKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 LAKE DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-455-4114
Mailing Address - Fax:616-455-4454
Practice Address - Street 1:4070 LAKE DR SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-455-4114
Practice Address - Fax:616-455-4454
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4387357Medicaid
MIM80080008Medicare PIN
F98016Medicare UPIN