Healthcare Provider Details

I. General information

NPI: 1770556839
Provider Name (Legal Business Name): SUZANNE C. SCHMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W359N5002 BROWN ST SUITE 208
OCONOMOWOC WI
53066-3366
US

IV. Provider business mailing address

W359N5002 BROWN ST SUITE 208
OCONOMOWOC WI
53066-3366
US

V. Phone/Fax

Practice location:
  • Phone: 262-560-1920
  • Fax:
Mailing address:
  • Phone: 262-560-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29581
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: