1649261868 NPI number — DR. MICHAEL WILLIAM SHULTZ DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649261868 NPI number — DR. MICHAEL WILLIAM SHULTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHULTZ
Provider First Name:
MICHAEL
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649261868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 STRUTHERS LIBERTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44405-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-750-1333
Provider Business Mailing Address Fax Number:
330-750-0203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 STRUTHERS LIBERTY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44405-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-750-1333
Provider Business Practice Location Address Fax Number:
330-750-0203
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34004267S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341563209 . This is a "AETNA CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34156320900 . This is a "UNITED HEALTHCARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000133995 . This is a "ANTHEM SENIOR ADVANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0665169 . This is a "OH WELFARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000133995 . This is a "ANTHEM CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000133995 . This is a "ANTHEM BENEFIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60322 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080011301 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 516931 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 516931 . This is a "SELECT BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000133995 . This is a "ANTHEM FEP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0599322 . This is a "MEDICARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0102261 . This is a "UHC OF COLUMBUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0665169 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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