Healthcare Provider Details

I. General information

NPI: 1568502136
Provider Name (Legal Business Name): JACOB JONAS CARMICHAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST STE 251
OLATHE KS
66061-7253
US

IV. Provider business mailing address

34800 BOB WILSON DR C/O PULMONARY MEDICINE
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 619-532-5990
  • Fax: 619-532-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-31507
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD2023-1334
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number04-31507
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04-31507
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: