Provider Demographics
NPI:1841295698
Name:SCHMIDT, JONNA LEIGH (MD)
Entity type:Individual
Prefix:
First Name:JONNA
Middle Name:LEIGH
Last Name:SCHMIDT
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 1:456 CROSS ST
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-9706
Mailing Address - Country:US
Mailing Address - Phone:517-448-8918
Mailing Address - Fax:517-448-4085
Practice Address - Street 1:456 CROSS ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-9706
Practice Address - Country:US
Practice Address - Phone:517-448-8918
Practice Address - Fax:517-448-4085
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2014-11-10
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
MIJS406858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3263838Medicaid
MA1104600681OtherBCBSM
MI03618OtherPARAMOUNT
E74855Medicare UPIN
MI3263838Medicaid