Healthcare Provider Details

I. General information

NPI: 1427176411
Provider Name (Legal Business Name): CAROLIESE SCHMIDT, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S PATRICK DR SUITE H
SATELLITE BEACH FL
32937-3963
US

IV. Provider business mailing address

1275 S PATRICK DR SUITE H
SATELLITE BEACH FL
32937-3963
US

V. Phone/Fax

Practice location:
  • Phone: 321-777-0600
  • Fax: 321-777-0601
Mailing address:
  • Phone: 321-777-0600
  • Fax: 321-777-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME54009
License Number StateFL

VIII. Authorized Official

Name: CAROLIESE SCHMIDT
Title or Position: PHYSICIAN AND OWNER
Credential: MD
Phone: 321-777-0600