=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932102613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE H SCHMITT III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 S WEBSTER AVE STE 401
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54301-3531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-432-7000
-----------------------------------------------------
Fax | 920-432-7451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 S WEBSTER AVE STE 401
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54301-3531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-432-7000
-----------------------------------------------------
Fax | 920-432-7451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 26875-020
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------