Healthcare Provider Details

I. General information

NPI: 1356396147
Provider Name (Legal Business Name): RACHEL L HUMMEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 W STREETSBORO ST
HUDSON OH
44236
US

IV. Provider business mailing address

82 W STREETSBORO ST
HUDSON OH
44236-2876
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-7650
  • Fax: 330-342-4399
Mailing address:
  • Phone: 330-344-7650
  • Fax: 330-342-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34-008327
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-008327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: