Provider Demographics
NPI:1285811000
Name:SCHMITZ, LISA MARIE (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SCHMITZ
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 1:721 AMERICAN AVE STE 410
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-2680
Mailing Address - Fax:
Practice Address - Street 1:721 AMERICAN AVE STE 410
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51220207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
683750800Medicare PIN