Provider Demographics
NPI:1215926399
Name:SCHMIDT, GRANT E (M D PH D)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:E
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:M D PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2300
Mailing Address - Country:US
Mailing Address - Phone:614-451-2280
Mailing Address - Fax:614-451-4352
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-451-2280
Practice Address - Fax:614-451-4352
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045930S207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473223Medicaid
OHC46415Medicare ID - Type Unspecified