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NPI Code Detail

MEDICARE: TINA M SCHMIDT PA

MEDICARE: TINA M SCHMIDT PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1679WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11679-023OTHERWILICENSE

General Provider Information

NPI Number : 1033194261
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA M SCHMIDT PA
Provider Business Mailing Address
First Line : PO BOX 22487
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-2487
Country : US
Telephone Number : 920-445-7222
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 1510 FREMONT ST
Second Line :
City : ALGOMA
State : WI
Zip : 54201-1948
Country : US
Telephone Number : 920-487-3676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 04/16/2013

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Directions to “ TINA M SCHMIDT PA” Practice Location

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