Provider Demographics
NPI:1215127162
Name:HYDE, RONALD ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALLEN
Last Name:HYDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2202
Mailing Address - Country:US
Mailing Address - Phone:616-523-1630
Mailing Address - Fax:616-523-1631
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2202
Practice Address - Country:US
Practice Address - Phone:616-523-1630
Practice Address - Fax:616-523-1631
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014682208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215127162Medicaid
MI020C410380OtherBCBS
MI1215127162Medicaid
MIC36179046Medicare PIN