1063583086 NPI number — MICHAEL P SCHMIDT MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063583086 NPI number — MICHAEL P SCHMIDT MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHMIDT

Provider First Name:

MICHAEL

Provider Middle Name:

P

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1063583086

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/14/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1590 SW 9TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOCA RATON

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33486-8414

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

561-400-4575

Provider Business Mailing Address Fax Number:

954-427-2504

Provider First Line Business Practice Location Address:

2345 W HILLSBORO BLVD STE 205

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DEERFIELD BEACH

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33442-1111

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

954-360-7769

Provider Business Practice Location Address Fax Number:

954-427-2504

Provider Enumeration Date:

11/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  ME0057364 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 101675 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
• Identifier: 10444 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 112110 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
• Identifier: 10444 . This is a "HEALTH OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: 13811 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 100030300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 650352916 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 015763 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 228675 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 2461ASOP . This is a "NHP" identifier . This identifiers is of the category "OTHER".
• Identifier: 14228 . This is a "VISTA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2511292012 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 5998615 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: 988484B . This is a "TOTAL HEALTH CHOICE" identifier . This identifiers is of the category "OTHER".