Provider Demographics
NPI:1740263920
Name:SCHMALZ, JULIET MARIE (MD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:MARIE
Last Name:SCHMALZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:MARIE
Other - Last Name:SCHMALZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT. 107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-802-6304
Practice Address - Fax:317-870-0499
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200456310Medicaid
IN134070IMedicare PIN
IN200456310Medicaid