Individual
MELISSA K HIDDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4700
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
15515-040
WI
207Q00000X
Family Medicine Physician
Primary
64157-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1092278690
AMERICAN BOARD OF FAMILY MEDICINE
—
Enumeration date
10/23/2011
Last updated
01/09/2023
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