Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 21523 | WI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 21523 | WI |
NPI | 1326154725 |
---|---|
Provider Name | Gary A Schmidt |
First Address | Manitowoc, WI 54221-2290 |
Second Address | Manitowoc, WI 54220-7316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001598644 02 | UNITED HEALTH (01) | WI |
080125211 | MEDICARE RAILROAD (01) | WI |
12521 | NETWORK HEALTH PLAN (01) | WI |
21523 | TOUCHPOINT (01) | WI |
30174800 | (05) | WI |
390806395 | CHAMPUS (01) | WI |
390806395 | WEA (01) | WI |
39080639508 | TRICARE (01) | WI |
B56376 | (02) | |
B56376 | CIGNA (01) | WI |