Provider Demographics
NPI:1497873384
Name:SCHMITZ, LESLIE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:SCHMITZ
Suffix:
Gender:F
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:PO BOX 11596
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4006
Mailing Address - Country:US
Mailing Address - Phone:574-607-4724
Mailing Address - Fax:
Practice Address - Street 1:3665 PARK PL W
Practice Address - Street 2:SUITE 300
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3566
Practice Address - Country:US
Practice Address - Phone:574-607-4724
Practice Address - Fax:574-607-4725
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003169A207RN0300X
IL036107587207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH89871Medicare UPIN
INPENDINGMedicare ID - Type Unspecified