Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101018729 | MI |
NPI | 1205147998 |
---|---|
Provider Name | Matthew L Carmichael |
First Address | Tulsa, OK 74136-1902 |
Second Address | Tulsa, OK 74136-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 21/06/2021 |