Basic Information
Provider Information
NPI: 1790976462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMITZ
FirstName: MATTHEW
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1746 COLE BLVD
Address2: SUITE 150
City: LAKEWOOD
State: CO
PostalCode: 804013208
CountryCode: US
TelephoneNumber: 3039148800
FaxNumber: 3037163777
Practice Location
Address1: 1746 COLE BLVD
Address2: SUITE 150
City: LAKEWOOD
State: CO
PostalCode: 804013208
CountryCode: US
TelephoneNumber: 3039148800
FaxNumber: 3037163777
Other Information
ProviderEnumerationDate: 08/07/2007
LastUpdateDate: 09/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085P0229XA120380CAN Allopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
2085P0229X52347CON Allopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
2085R0202XDR.0052347COY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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