Provider Demographics
NPI:1639791049
Name:SCHMIDT, GRANT OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:OLIVER
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 1:550 S. JACKSON STREET
Mailing Address - Street 2:ACB, 1ST FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-6902
Mailing Address - Fax:
Practice Address - Street 1:550 S. JACKSON STREET
Practice Address - Street 2:ACB, 1ST FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program