Basic Information
| Provider Information | |||||||||
| NPI: | 1407800014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 TOWER DR | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | SUN PRAIRIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535901239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088253008 | ||||||||
| FaxNumber: | 6088253794 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 TOWER DR | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | SUN PRAIRIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535901239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088253008 | ||||||||
| FaxNumber: | 6088253794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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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 | 19355-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31035600 | 05 | WI | MEDICAID | 234 | 01 | WI | DEAN HEALTH INNSURANCE | OTHER |