Basic Information
Provider Information
NPI: 1396366969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMITZ
FirstName: DAVID
MiddleName: ARTHUR
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 395 W 12TH AVE RM 414
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432101267
CountryCode: US
TelephoneNumber: 6143660768
FaxNumber: 6142936935
Practice Location
Address1: 395 W 12TH AVE RM 414
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432101267
CountryCode: US
TelephoneNumber: 6143660768
FaxNumber: 6142936935
Other Information
ProviderEnumerationDate: 05/05/2020
LastUpdateDate: 07/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X57.251530OHY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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