Provider Demographics
NPI:1235175118
Name:VEENEMAN, EMILY T (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:T
Last Name:VEENEMAN
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:100 MALLARD CREEK RD
Practice Address - Street 2:STE. 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4194
Practice Address - Country:US
Practice Address - Phone:502-855-6125
Practice Address - Fax:502-394-1972
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11010746A207RE0101X
KY40281207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64128853Medicaid
KYP00777635Medicare PIN
KY64128853Medicaid
CF9195Medicare UPIN