Healthcare Provider Details

I. General information

NPI: 1962508374
Provider Name (Legal Business Name): KAREN M HUMMEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CARRICK DR STE 150
MEDINA OH
44256-5392
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR - BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 330-721-8500
  • Fax: 330-721-8510
Mailing address:
  • Phone: 330-721-8500
  • Fax: 330-721-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35071126
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35071126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: