Provider Demographics
NPI:1649533704
Name:VAN GEMERT, LEILA DANIELLE (DO)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:DANIELLE
Last Name:VAN GEMERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 BROADMEAD WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-5784
Mailing Address - Country:US
Mailing Address - Phone:812-243-0945
Mailing Address - Fax:
Practice Address - Street 1:1409 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-9524
Practice Address - Country:US
Practice Address - Phone:828-435-8400
Practice Address - Fax:828-435-8401
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004442A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine