Provider Demographics
NPI:1356159958
Name:SCHMITZ, KEVIN J
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 LADURON DR
Mailing Address - Street 2:
Mailing Address - City:MISHICOT
Mailing Address - State:WI
Mailing Address - Zip Code:54228-9610
Mailing Address - Country:US
Mailing Address - Phone:920-769-6594
Mailing Address - Fax:
Practice Address - Street 1:937 LADURON DR
Practice Address - Street 2:
Practice Address - City:MISHICOT
Practice Address - State:WI
Practice Address - Zip Code:54228-9610
Practice Address - Country:US
Practice Address - Phone:920-769-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare