Provider Demographics
NPI:1669533055
Name:SCHMIDT, WILLIAM ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
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 1:8891 AIRPORT ROAD
Mailing Address - Street 2:BOX C4
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7262
Mailing Address - Country:US
Mailing Address - Phone:763-780-2987
Mailing Address - Fax:763-784-6219
Practice Address - Street 1:9420 NOVEMBER STREET
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:763-780-2987
Practice Address - Fax:763-784-6219
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94325Medicare UPIN
112610606Medicare ID - Type Unspecified