Provider Demographics
NPI:1194704718
Name:SCHMIDT, KELLY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JAY
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5100 PRAIRIE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-553-0828
Mailing Address - Fax:319-277-7548
Practice Address - Street 1:5100 PRAIRIE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-553-0828
Practice Address - Fax:319-277-7548
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA30041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7097683Medicaid
IA8097683Medicaid
IA080091823OtherRR MEDICARE
IAF87155Medicare UPIN
IA080091823OtherRR MEDICARE