Provider Demographics
NPI:1538337969
Name:DR RANDY L CARMICHAEL
Entity type:Organization
Organization Name:DR RANDY L CARMICHAEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROP
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-332-3232
Mailing Address - Street 1:3937 W ROLL AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3181
Mailing Address - Country:US
Mailing Address - Phone:812-332-3232
Mailing Address - Fax:812-332-3273
Practice Address - Street 1:3937 W ROLL AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3181
Practice Address - Country:US
Practice Address - Phone:812-332-3232
Practice Address - Fax:812-332-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8000787261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center