Healthcare Provider Details

I. General information

NPI: 1902247950
Provider Name (Legal Business Name): ALISIA M SCHMIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISIA M KLOSTERMANN PA-C

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PARK PL
SWANSEA IL
62226-2965
US

IV. Provider business mailing address

PO BOX 419059
SAINT LOUIS MO
63141-9059
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-7500
  • Fax: 618-277-4236
Mailing address:
  • Phone: 182-777-5006
  • Fax: 618-277-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.004678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: