Provider Demographics
NPI:1427176411
Name:CAROLIESE SCHMIDT, MD PA
Entity type:Organization
Organization Name:CAROLIESE SCHMIDT, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLIESE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-777-0600
Mailing Address - Street 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-777-0600
Mailing Address - Fax:321-777-0601
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:SUITE H
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-777-0600
Practice Address - Fax:321-777-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6137Medicare ID - Type UnspecifiedORGANIZATIONAL ID