Provider Demographics
NPI:1811199235
Name:SCHMIDT, KELLY SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMONS WAY STE B
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1915
Mailing Address - Country:US
Mailing Address - Phone:406-752-5170
Mailing Address - Fax:406-752-5210
Practice Address - Street 1:200 COMMONS WAY STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5170
Practice Address - Fax:406-752-5210
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13123207T00000X
MT548092086S0120X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV207T0000XMedicaid
NV13123NVOtherBLUE CROSS BLUE SHIELD
AZ449672Medicaid
NV13123NVOtherBLUE CROSS BLUE SHIELD