Provider Demographics
NPI:1851353106
Name:SCHMIDT, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:1116 N 16TH ST
Mailing Address - Street 2:STE. B
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2119
Mailing Address - Country:US
Mailing Address - Phone:765-428-2500
Mailing Address - Fax:765-428-2505
Practice Address - Street 1:1116 N 16TH ST
Practice Address - Street 2:STE. B
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2119
Practice Address - Country:US
Practice Address - Phone:765-428-2500
Practice Address - Fax:765-428-2505
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039902A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100340630Medicaid
INF24510Medicare UPIN
INM400015099Medicare PIN
IN100340630Medicaid