1649261868 NPI number — DR. MICHAEL WILLIAM SHULTZ DO

Table of content: DR. FRANCO RUSSO M.D. (NPI 1518378124)

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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