Provider Demographics
NPI:1669641692
Name:HIERHOLZER, MELINDA B (DO)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:B
Last Name:HIERHOLZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:B
Other - Last Name:SARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:
Practice Address - Street 1:9611 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2334
Practice Address - Country:US
Practice Address - Phone:954-924-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-24
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11250208000000X
PAOT12341208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14F0WOtherBCBS OF FLORIDA
FL003743100Medicaid
FL14F0WOtherBCBS OF FLORIDA