Provider Demographics
NPI:1811929219
Name:HSU-LUMETTA, JENNIE C (MD)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:C
Last Name:HSU-LUMETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:1701 W. CURTIS ROAD
Practice Address - Street 2:ADULT MEDICINE
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-365-6502
Practice Address - Fax:217-365-6380
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036108920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH95680Medicare UPIN
ILIL3270059Medicare PIN
H95680Medicare UPIN
IL6447860004Medicare NSC