Provider Demographics
NPI:1265440481
Name:SCHMIDT, TERRY (PA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 CLEAVER RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1143
Mailing Address - Country:US
Mailing Address - Phone:888-758-5709
Mailing Address - Fax:888-491-7220
Practice Address - Street 1:1184 CLEAVER RD
Practice Address - Street 2:STE. 300
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1143
Practice Address - Country:US
Practice Address - Phone:888-758-5709
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N61280Medicare ID - Type Unspecified
MIR67197Medicare UPIN