Provider Demographics
NPI:1629257266
Name:SCHMIDT, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SCHMIDT
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 1:1 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3353
Mailing Address - Country:US
Mailing Address - Phone:501-776-6093
Mailing Address - Fax:501-776-6019
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE GL-2
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-776-6093
Practice Address - Fax:501-776-6019
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4095825OtherAETNA
AR5J267OtherBLUE CROSS BLUE SHIELD
AR140650000OtherQUALCHOICE
AR1720037OtherUNITED HEALTH CARE
AR124391001Medicaid
AR1720037OtherUNITED HEALTH CARE
AR4095825OtherAETNA