Healthcare Provider Details

I. General information

NPI: 1639557721
Provider Name (Legal Business Name): RYAN SCHMIDT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-5743
  • Fax:
Mailing address:
  • Phone: 219-983-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02005636A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: