Provider Demographics
NPI:1568630804
Name:JONNA L SCHMIDT M D PC
Entity Type:Organization
Organization Name:JONNA L SCHMIDT M D PC
Other - Org Name:JONNA L SCHMIDT MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-448-8918
Mailing Address - Street 1:456 CROSS ST
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-9706
Mailing Address - Country:US
Mailing Address - Phone:517-448-8918
Mailing Address - Fax:517-448-4085
Practice Address - Street 1:456 CROSS ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-9706
Practice Address - Country:US
Practice Address - Phone:517-448-8918
Practice Address - Fax:517-448-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS406858261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3263838Medicaid
MI03618OtherPARAMOUNT
1104600681OtherBCBSM
MI5854OtherHEALTH PLAN OF MI
MI5854OtherHEALTH PLAN OF MI
MIE74855Medicare UPIN