Provider Demographics
NPI:1326154725
Name:SCHMIDT, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:SCHMIDT
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 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-4500
Mailing Address - Fax:920-682-9378
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:920-682-9378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21523207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0001598644 02OtherUNITED HEALTH
WI12521OtherNETWORK HEALTH PLAN
WI30174800Medicaid
WI390806395OtherCHAMPUS
WI390806395OtherWEA
WI39080639508OtherTRICARE
WIB56376OtherCIGNA
WI080125211OtherMEDICARE RAILROAD
WI21523OtherTOUCHPOINT
WI390806395OtherCHAMPUS
WI390806395OtherWEA