Provider Demographics
NPI:1043283351
Name:SCHNELL, MARTIN N (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:N
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-2013
Mailing Address - Country:US
Mailing Address - Phone:352-409-4404
Mailing Address - Fax:352-324-6294
Practice Address - Street 1:9400 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:HOWEY IN THE HILLS
Practice Address - State:FL
Practice Address - Zip Code:34737-5012
Practice Address - Country:US
Practice Address - Phone:352-409-4404
Practice Address - Fax:352-324-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62430207P00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17690OtherBCBS
FL370692300Medicaid
TN4122079OtherBLUECROSS BLUESHIELD OF T
FL370692300Medicaid
FL370692300Medicaid
E19935Medicare UPIN
TN3325745Medicare PIN