Provider Demographics
NPI:1811942519
Name:HULST, LYNDA LU (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:LU
Last Name:HULST
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 1:2432 SANTA MONICA DR SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3548
Mailing Address - Country:US
Mailing Address - Phone:616-648-9435
Mailing Address - Fax:
Practice Address - Street 1:2000 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5837
Practice Address - Country:US
Practice Address - Phone:616-648-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811942519Medicaid
MI4749465Medicaid
MI4777998Medicaid
MI4876978Medicaid
MI4778000Medicaid
MI4777989Medicaid
MI4749474Medicaid
MI4749474Medicaid
MIM69390237Medicare ID - Type Unspecified
MI4777989Medicaid
MI4749465Medicaid