Provider Demographics
NPI:1104056670
Name:SCHMITT, JILL (DO)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64321 VAN DYKE RD
Practice Address - Street 2:BEAUMONT CLEARWATER FAMILY PRACTICE
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48095-2578
Practice Address - Country:US
Practice Address - Phone:586-281-6000
Practice Address - Fax:586-281-6001
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510108320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080F370780OtherBCBSM
MI0F37078142Medicare PIN