Provider Demographics
NPI:1346268034
Name:SCHMIDT, PHILIP M (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
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 1:3207 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5100
Mailing Address - Country:US
Mailing Address - Phone:719-591-6666
Mailing Address - Fax:719-573-0731
Practice Address - Street 1:3207 N ACADEMY BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5100
Practice Address - Country:US
Practice Address - Phone:719-591-6666
Practice Address - Fax:719-573-0731
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23794207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1237940Medicaid
G1738Medicare ID - Type Unspecified
CO1237940Medicaid