Basic Information
| Provider Information | |||||||||
| NPI: | 1386672046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | GEORG | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5515 CLEVELAND AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | STEVENSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694296604 | ||||||||
| FaxNumber: | 2694291715 | ||||||||
| Practice Location | |||||||||
| Address1: | 5515 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENSVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491279670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694299644 | ||||||||
| FaxNumber: | 2694294002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301051325 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3501108721 | 01 | MI | BLUE CROSS PIN | OTHER | 370004517 | 01 | MI | RAILROAD MEDICARE | OTHER | 2893951 | 05 | MI | MEDICAID | AS8333495 | 01 | MI | DEA | OTHER |