Provider Demographics
NPI:1154315224
Name:SCHMIDT, PHYLLIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:I
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 SPRING MILL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2335
Mailing Address - Country:US
Mailing Address - Phone:317-255-7044
Mailing Address - Fax:
Practice Address - Street 1:8415 SPRING MILL CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2335
Practice Address - Country:US
Practice Address - Phone:317-255-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010215682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000201672OtherANTHEM #
IN5553113OtherAETNA #
INP00927199OtherRAILROAD MEDICARE
IN200074750Medicaid
IN200346250Medicaid
INP00927199OtherRAILROAD MEDICARE
IN200346250Medicaid
IN5553113OtherAETNA #
IN184870BMedicare ID - Type UnspecifiedINDIVIDUAL #