Provider Demographics
NPI:1487653408
Name:SCHMELTZ, MARK P (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:SCHMELTZ
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 1:3245 HEALTH DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12340 BITTERSWEET COMMONS BLVD W
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6959
Practice Address - Country:US
Practice Address - Phone:574-271-8610
Practice Address - Fax:574-271-8620
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002103A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200243660Medicaid
IN200243660Medicaid
IN200243660Medicaid
MI0N9906001Medicare PIN
H00640Medicare UPIN
INP00750873Medicare PIN
P00147707 RR MED#Medicare PIN
IN000000632271OtherANTHEM
MI0851400114OtherANTHEN BCBS
IN262990BMedicare PIN
IN200243660Medicaid