Individual
MR. KEVIN KIRKWOOD SCHMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10767 ILLINOIS ST STE 3000, CARMEL, IN 46032-8972
(317) 817-1200
(317) 817-1220
Mailing address
10767 ILLINOIS ST STE 3000, CARMEL, IN 46032-8972
(317) 817-1200
(317) 817-1220
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10000460A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000290615
ANTHEM
IN
01
—
000000596241
ANTHEM - CIPA
IN
01
—
000000603577
ANTHEM - TIPTON HOSPITAL
IN
01
—
10000460A
INDIANA LICENSE
IN
01
—
1041479
NCCPA CERTIFICATION #
—
01
—
11480220
CAQH
—
01
—
256870Q
MEDICARE PIN - CIPA
IN
01
—
970023217
MEDICARE RAIL ROAD
IN
Enumeration date
08/24/2006
Last updated
07/26/2023
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