Healthcare Provider Details

I. General information

NPI: 1487186854
Provider Name (Legal Business Name): MARTIN HUMMEL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ALEX BELL RD
CENTERVILLE OH
45459-2658
US

IV. Provider business mailing address

1235 E ALEX BELL RD
CENTERVILLE OH
45459-2658
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6400
  • Fax: 937-435-4793
Mailing address:
  • Phone: 937-435-6400
  • Fax: 937-435-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAN1682
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: