Basic Information
| Provider Information | |||||||||
| NPI: | 1326154725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542212290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203204500 | ||||||||
| FaxNumber: | 9206829378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 S 41ST ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542207316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203204500 | ||||||||
| FaxNumber: | 9206829378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21523 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 21523 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0001598644 02 | 01 | WI | UNITED HEALTH | OTHER | 12521 | 01 | WI | NETWORK HEALTH PLAN | OTHER | 30174800 | 05 | WI | MEDICAID | 390806395 | 01 | WI | CHAMPUS | OTHER | 390806395 | 01 | WI | WEA | OTHER | 39080639508 | 01 | WI | TRICARE | OTHER | B56376 | 01 | WI | CIGNA | OTHER | 080125211 | 01 | WI | MEDICARE RAILROAD | OTHER | 21523 | 01 | WI | TOUCHPOINT | OTHER |