Provider Demographics
NPI:1568579498
Name:SCHMIDT, KEVIN KIRKWOOD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:KIRKWOOD
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10767 ILLINOIS ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8972
Mailing Address - Country:US
Mailing Address - Phone:317-817-1200
Mailing Address - Fax:317-817-1220
Practice Address - Street 1:10767 ILLINOIS ST STE 3000
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8972
Practice Address - Country:US
Practice Address - Phone:317-817-1200
Practice Address - Fax:317-817-1220
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000460A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041479OtherNCCPA CERTIFICATION #
IN970023217OtherMEDICARE RAIL ROAD
IN000000290615OtherANTHEM
IN000000596241OtherANTHEM - CIPA
11480220OtherCAQH
IN000000603577OtherANTHEM - TIPTON HOSPITAL
IN10000460AOtherINDIANA LICENSE
IN256870QOtherMEDICARE PIN - CIPA
IN000000290615OtherANTHEM
IN231060BMedicare UPIN
IN256870QOtherMEDICARE PIN - CIPA