Provider Demographics
NPI:1609812759
Name:HOYME, KERMIT DAN (MD)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:DAN
Last Name:HOYME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1367
Mailing Address - Country:US
Mailing Address - Phone:708-423-8706
Mailing Address - Fax:708-423-8659
Practice Address - Street 1:10400 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1367
Practice Address - Country:US
Practice Address - Phone:708-423-8706
Practice Address - Fax:708-423-8659
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 057763208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057763Medicaid
C42567Medicare UPIN
IL036057763Medicaid
211475Medicare PIN