Provider Demographics
NPI:1104988617
Name:SCHMIDT, PATRICIA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:SCHMIDT
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 1:30400 TELEGRAPH RD
Mailing Address - Street 2:SUITE 334
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4537
Mailing Address - Country:US
Mailing Address - Phone:800-311-5365
Mailing Address - Fax:248-681-8927
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 334
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:800-311-5365
Practice Address - Fax:248-681-8927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3203132Medicaid
MIF10824Medicare UPIN
MA3203132Medicaid