Provider Demographics
NPI:1235151895
Name:SCHMITT, JOHN ELMER JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ELMER
Last Name:SCHMITT
Suffix:JR
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:COMMUNITY MEMORIAL HOSPITAL
Mailing Address - Street 2:512 SKYLINE BLVD
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1199
Mailing Address - Country:US
Mailing Address - Phone:218-879-4641
Mailing Address - Fax:320-763-5749
Practice Address - Street 1:COMMUNITY MEMORIAL HOSPITAL
Practice Address - Street 2:512 SKYLINE BLVD
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1199
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9186207Y00000X
OH35044002207Y00000X
MN45382207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77139Medicare UPIN
E77139Medicare UPIN
MN040001099Medicare PIN