1962401182 NPI number — DANIEL C SCHULTZ D.O.

Table of content: DANIEL C SCHULTZ D.O. (NPI 1962401182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962401182 NPI number — DANIEL C SCHULTZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
DANIEL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1962401182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23625 COMMERCE PARK
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-255-5725
Provider Business Mailing Address Fax Number:
866-904-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BELLEFONTAINE AVENUE
Provider Second Line Business Practice Location Address:
LIMA MEMORIAL HEALTH SYSTEM
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-228-3335
Provider Business Practice Location Address Fax Number:
419-226-5064
Provider Enumeration Date:
07/19/2005

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: 2085R0202X , with the licence number:  5101015199 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 34 004758S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 34-004758 , 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: DS015199 . This is a "BC/BS INDIVIDUAL PIN NO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 300129241 . This is a "RR MDCR INDIVIDUAL PIN NO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114370467 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64867591 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10814679 . This is a "CAQH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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