Provider Demographics
NPI:1568250025
Name:MITCHEM, CARL E SR
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:E
Last Name:MITCHEM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 E MCMILLAN ST STE B4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1959
Mailing Address - Country:US
Mailing Address - Phone:513-975-8201
Mailing Address - Fax:
Practice Address - Street 1:656 E MCMILLAN ST STE B4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1959
Practice Address - Country:US
Practice Address - Phone:513-975-8201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty