Provider Demographics
NPI:1306420104
Name:MCMICHAEL, KIYA LA TRICE
Entity type:Individual
Prefix:
First Name:KIYA
Middle Name:LA TRICE
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13306 THORNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6847
Mailing Address - Country:US
Mailing Address - Phone:216-304-0400
Mailing Address - Fax:
Practice Address - Street 1:13306 THORNHURST AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6847
Practice Address - Country:US
Practice Address - Phone:216-304-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH560582Medicaid