Provider Demographics
NPI:1841302965
Name:HEMMILA, JAY M (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:HEMMILA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 14500 NW 7735
Mailing Address - Street 2:NORTH MEMORIAL HOSPITAL MEDICINE SERVICE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-7735
Mailing Address - Country:US
Mailing Address - Phone:763-520-2827
Mailing Address - Fax:763-520-1022
Practice Address - Street 1:3300 OAKDALE AVE NORTH
Practice Address - Street 2:NORTH MEMORIAL HEALTH CARE
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-2827
Practice Address - Fax:763-520-1022
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34085300Medicaid
1367513OtherAMERICAS PPO
1027554OtherPREFERRED ONE
140385OtherUCARE MN
75B89HEOtherBLUE CROSS BLUE SHIELD
403072OtherMEDICA
140385OtherUCARE MN