Provider Demographics
NPI:1013979541
Name:HEMSTREET, MITZI K (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:K
Last Name:HEMSTREET
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 INGOMAR HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-4263
Mailing Address - Country:US
Mailing Address - Phone:412-867-9759
Mailing Address - Fax:412-367-5855
Practice Address - Street 1:7777 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-3409
Practice Address - Country:US
Practice Address - Phone:412-867-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22559207L00000X
PAMD420691207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006746Medicaid
WV001907643OtherMSBCBS GROUP
WV001930180OtherMSBCBS
WV0207026000Medicaid
WV2004563000Medicaid
WV001930180OtherMSBCBS
WV9364011Medicare PIN
WV9333201Medicare PIN
WV$$$$$$$$$00OtherOHIO WORKERS COMP
WV001930180OtherMSBCBS
WV3810006746Medicaid