Healthcare Provider Details

I. General information

NPI: 1235151895
Provider Name (Legal Business Name): JOHN ELMER SCHMITT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD
CLOQUET MN
55720-1199
US

IV. Provider business mailing address

COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BLVD
CLOQUET MN
55720-1199
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4641
  • Fax:
Mailing address:
  • Phone: 218-879-4641
  • Fax: 320-763-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9186
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35044002
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number45382
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: