Healthcare Provider Details

I. General information

NPI: 1306736319
Provider Name (Legal Business Name): PAUL SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 OLD GREEN BAY RD
MOUNT PLEASANT WI
53403-9489
US

IV. Provider business mailing address

4328 OLD GREEN BAY RD
MOUNT PLEASANT WI
53403-9489
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-7606
  • Fax:
Mailing address:
  • Phone: 734-725-8614
  • Fax: 262-687-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8758-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: