Provider Demographics
NPI:1609878883
Name:SCHMIDT, CAROL ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELISABETH
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-777-0600
Mailing Address - Fax:321-777-0601
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2624
Practice Address - Country:US
Practice Address - Phone:321-726-1600
Practice Address - Fax:321-726-1610
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259117100Medicaid
E22859Medicare UPIN
FL08209BMedicare UPIN