Provider Demographics
NPI:1710984729
Name:HEMMER, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:HEMMER
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 1:2210 DEAN ST STE L
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1059
Mailing Address - Country:US
Mailing Address - Phone:630-461-9833
Mailing Address - Fax:847-741-8587
Practice Address - Street 1:2210 DEAN ST STE L
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1059
Practice Address - Country:US
Practice Address - Phone:630-461-9833
Practice Address - Fax:847-741-8587
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052972Medicaid
ILP01529Medicare PIN
ILL86171Medicare PIN