Individual
MELONIE SUE ICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 EAST PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546
(616) 459-3158
(616) 988-0071
Mailing address
1000 EAST PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-3680
(616) 459-3158
(616) 988-0071
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301406808
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104128442
BCBS OF MICHIGAN
MI
05
—
1989421
—
MI
Enumeration date
08/24/2006
Last updated
10/11/2022
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