Provider Demographics
NPI:1861469496
Name:HASS, MELINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:M
Last Name:HASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:M
Other - Last Name:MCFARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 JOHN DEERE RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6869
Mailing Address - Country:US
Mailing Address - Phone:309-779-4850
Mailing Address - Fax:309-779-4855
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-4850
Practice Address - Fax:309-779-4855
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104809208600000X
IA34185208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01238938OtherRR MEDICARE
IL036104809Medicaid
IL200715049Medicare PIN
ILG40911Medicare UPIN
ILL86077Medicare PIN
IA719260578Medicare PIN