Healthcare Provider Details

I. General information

NPI: 1639916802
Provider Name (Legal Business Name): JACOB SCHMIDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 14TH ST # HA6065
INDIANAPOLIS IN
46202-2369
US

IV. Provider business mailing address

350 W 14TH ST # HA6065
INDIANAPOLIS IN
46202-2369
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0267
  • Fax:
Mailing address:
  • Phone: 317-274-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01100603A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: