Provider Demographics
NPI:1801856588
Name:SCHMIDT, DEREK J (MD)
Entity Type:Individual
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First Name:DEREK
Middle Name:J
Last Name:SCHMIDT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5340
Mailing Address - Fax:952-853-8727
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8550
Practice Address - Fax:651-254-8558
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2019-07-09
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Provider Licenses
StateLicense IDTaxonomies
MN47090207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN996420700Medicaid