Provider Demographics
NPI:1831185149
Name:SCHMITT, STEPHANIE L (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:SCHMITT
Suffix:
Gender:F
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:PO BOX 102101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2101
Mailing Address - Country:US
Mailing Address - Phone:863-603-6565
Mailing Address - Fax:863-603-6576
Practice Address - Street 1:1417 LAKELAND HILLS BLVD
Practice Address - Street 2:202
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3200
Practice Address - Country:US
Practice Address - Phone:863-687-1259
Practice Address - Fax:863-284-1786
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60423208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14319OtherBCBS OF FLORIDA
FL255291400Medicaid
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL1497748743OtherGROUP NPI NUMBER / LRHSI
FL14319OtherBCBS OF FLORIDA
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER