Provider Demographics
NPI:1902396047
Name:CARMICHAEL, SUMETRA D
Entity Type:Individual
Prefix:
First Name:SUMETRA
Middle Name:D
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 CONSTANCE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4702
Mailing Address - Country:US
Mailing Address - Phone:937-867-6109
Mailing Address - Fax:
Practice Address - Street 1:8750 CONSTANCE LN # 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4702
Practice Address - Country:US
Practice Address - Phone:193-786-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270187Medicaid