Healthcare Provider Details

I. General information

NPI: 1104056670
Provider Name (Legal Business Name): JILL SCHMITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64321 VAN DYKE RD BEAUMONT CLEARWATER FAMILY PRACTICE
WASHINGTON TWP MI
48095-2578
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 586-281-6000
  • Fax: 586-281-6001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number510108320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: