Provider Demographics
NPI:1659948768
Name:SCHMITZ, DESTINEE ROSE (MD)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:ROSE
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DESTINEE
Other - Middle Name:ROSE
Other - Last Name:IRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5510 UTICA RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2935
Mailing Address - Country:US
Mailing Address - Phone:563-424-2025
Mailing Address - Fax:
Practice Address - Street 1:5510 UTICA RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2935
Practice Address - Country:US
Practice Address - Phone:563-424-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-52983208000000X
IAR-121612084N0402X
IAR-12801208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology