Provider Demographics
NPI:1730346289
Name:KINDER, MELISSA RAE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RAE
Last Name:KINDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RAE
Other - Last Name:KINDER TIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5754
Mailing Address - Country:US
Mailing Address - Phone:503-498-8190
Mailing Address - Fax:503-305-7425
Practice Address - Street 1:10121 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 235
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5754
Practice Address - Country:US
Practice Address - Phone:503-498-8190
Practice Address - Fax:503-305-7425
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161983208200000X, 2082S0105X
OH35097074208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500656021Medicaid
OHH006001Medicare PIN
OHH006000Medicare PIN