MEDICARE: KEVIN W SCHMIDTKE D.P.M.

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	720	NC

General Provider Information

NPI Number	:	1427444215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN W SCHMIDTKE D.P.M.

Provider Business Mailing Address
First Line	:	200 WESTGATE DR STE A
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8038
Country	:	US
Telephone Number	:	910-295-7400
Fax Number	:	877-295-0079

Provider Business Practice Location Address
First Line	:	200 WESTGATE DR STE A
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8038
Country	:	US
Telephone Number	:	910-295-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	10/14/2019

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