Healthcare Provider Details

I. General information

NPI: 1073876249
Provider Name (Legal Business Name): CATHLEEN SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

832 PINEWOOD DR
COLUMBUS MI
48063-3227
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5437
  • Fax: 800-248-1568
Mailing address:
  • Phone: 586-484-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: