Provider Demographics
NPI:1699946244
Name:HEDMAN, JAMIE A (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:HEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:A
Other - Last Name:JOEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11055 TWIN CREEKS CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2204
Practice Address - Country:US
Practice Address - Phone:260-425-6120
Practice Address - Fax:260-425-6115
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068787A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200994270Medicaid
INM400047859Medicare PIN
INM400027309Medicare PIN
IN200994270Medicaid