Healthcare Provider Details

I. General information

NPI: 1437374550
Provider Name (Legal Business Name): MICHAEL J SCHMIDT FACS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DR SUITE 308
BENTON AR
72015-3729
US

IV. Provider business mailing address

5 MEDICAL PARK DR SUITE 308
BENTON AR
72015-3729
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-7808
  • Fax: 501-315-4888
Mailing address:
  • Phone: 501-315-7808
  • Fax: 501-315-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN8431
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL SCHMIDT
Title or Position: DR OWNER
Credential: FACS
Phone: 501-315-7808