Provider Demographics
NPI:1699904888
Name:SCHMIDT, MONICA ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ELIZABETH
Last Name:SCHMIDT
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:PSC 26 BOX 36
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09447-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 MISSION HILLS DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5586
Practice Address - Country:US
Practice Address - Phone:166-178-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04864207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36.168014OtherSTATE LICENSE
GA98286OtherSTATE LICENSE
NECOPS147OtherSTATE LICENSE
TXU8496OtherSTATE LICENSE
TN5550OtherSTATE LICENSE
COCDR.0003489OtherSTATE LICENSE
DCDO210012343OtherSTATE LICENSE
MIEMC0004369OtherSTATE LICENSE
IN02007600AOtherSTATE LICENSE
OH34C.000232OtherSTATE LICENSE
AL3501OtherSTATE LICENSE
IADO-04864OtherSTATE LICENSE
WADO.OP.61515017-IMLCOtherSTATE LICENSE