Provider Demographics
NPI:1336255900
Name:SCHMALZ, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SCHMALZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3209 E FULLERTON PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3209
Mailing Address - Country:US
Mailing Address - Phone:812-825-6102
Mailing Address - Fax:812-825-6148
Practice Address - Street 1:3209 W FULLERTON PIKE
Practice Address - Street 2:SUITE E
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4060
Practice Address - Country:US
Practice Address - Phone:812-825-6102
Practice Address - Fax:812-825-6148
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01024519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100170580Medicaid
IN252770DMedicare PIN
INB29126Medicare UPIN