Provider Demographics
NPI:1144211566
Name:SCHMITT, PHILIP T (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:T
Last Name:SCHMITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1176
Mailing Address - Country:US
Mailing Address - Phone:248-673-0500
Mailing Address - Fax:248-673-6077
Practice Address - Street 1:4800 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1176
Practice Address - Country:US
Practice Address - Phone:248-673-0500
Practice Address - Fax:248-673-6077
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-06-11
Deactivation Date:2018-11-07
Deactivation Code:
Reactivation Date:2018-11-15
Provider Licenses
StateLicense IDTaxonomies
MI5101011432207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5606110001OtherADMINISTAR FED DME RSC
MI3515800 TYPE 11Medicaid
MIPS011432OtherBLUE CROSS BLUE SHIELD
MI5606110003OtherADMINISTAR FED DME HARTLAND
MIC5885OtherMCARE
MI2056303955OtherBCBSM PIN
MI4090042 TYPE 11Medicaid
MI5449487OtherAETNA
MI5606110003OtherADMINISTAR FED DME HARTLAND
MI0M72050002Medicare ID - Type Unspecified