Provider Demographics
NPI:1750576211
Name:SCHMIDT, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
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 1:300 W LINCOLN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1987
Mailing Address - Country:US
Mailing Address - Phone:618-277-0475
Mailing Address - Fax:618-277-0593
Practice Address - Street 1:300 W LINCOLN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1987
Practice Address - Country:US
Practice Address - Phone:618-277-0475
Practice Address - Fax:618-277-0593
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065962207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065962Medicaid
IL209222Medicare PIN