Provider Demographics
NPI:1194836015
Name:SCHMIDT, MARTIN JR (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SCHMIDT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3390
Mailing Address - Fax:812-242-3384
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3390
Practice Address - Fax:812-242-3384
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028682A207RG0100X
IL36094123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089608OtherANTHEM
INP00834923OtherRAILROAD MEDICARE
110020086OtherRAILROAD MCARE PALAMETTO
IN100251820LMedicaid
IN100251820Medicaid
IN859910EEMedicare PIN
IN192770GGGMedicare PIN
IN100251820LMedicaid
IN100251820Medicaid