Provider Demographics
NPI:1609870948
Name:SCHMIESING, MICHAEL DALE (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DALE
Last Name:SCHMIESING
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:320 EBAUGH ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1811
Practice Address - Country:US
Practice Address - Phone:712-527-5204
Practice Address - Fax:712-527-9346
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD5550207Q00000X
IA38558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731708Medicaid
SD5611733Medicaid
SD5611734Medicaid
NE47068731712Medicaid
IA1609870948Medicaid
NE47068731777Medicaid
IA058970008Medicare PIN
NE47068731777Medicaid
IA075120002Medicare PIN
SDS101190Medicare PIN