Provider Demographics
NPI:1710984638
Name:HEMELT, VIRGINIA B (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:B
Last Name:HEMELT
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 1:3217 W ALTO RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4609
Mailing Address - Country:US
Mailing Address - Phone:765-438-0832
Mailing Address - Fax:
Practice Address - Street 1:750 E TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3621
Practice Address - Country:US
Practice Address - Phone:815-455-1800
Practice Address - Fax:815-455-1875
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047250A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200158180Medicaid
IN200158180Medicaid
234220FMedicare PIN