Healthcare Provider Details

I. General information

NPI: 1134056336
Provider Name (Legal Business Name): COREY MICHAEL SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CLARKSON RD
CHESTERFIELD MO
63017-7398
US

IV. Provider business mailing address

952 BRIDGEPORT DR
BALLWIN MO
63011-2321
US

V. Phone/Fax

Practice location:
  • Phone: 636-778-9989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: