Provider Demographics
NPI:1184078693
Name:ETIENNE, SCHMID
Entity type:Individual
Prefix:
First Name:SCHMID
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 W HOLLYWOOD AVE
Mailing Address - Street 2:APT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4550
Mailing Address - Country:US
Mailing Address - Phone:773-310-4611
Mailing Address - Fax:
Practice Address - Street 1:1061 W HOLLYWOOD AVE
Practice Address - Street 2:APT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4550
Practice Address - Country:US
Practice Address - Phone:773-310-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor