Individual
MICHELLE JACKSON SUMRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 RING RD, ELIZABETHTOWN, KY 42701-8968
(270) 765-2107
(270) 169-9642
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37097
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000225528
ANTHEM
KY
05
—
300052072
—
IN
05
—
64049216
—
KY
01
—
K182871
MEDICARE
KY
Enumeration date
01/10/2006
Last updated
04/24/2024
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