Basic Information
| Provider Information | |||||||||
| NPI: | 1578044616 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEVEN SCHULTZ, MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STEVEN SCHULTZ, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4217 28TH AVE NW STE 111 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730698358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053104211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4217 28TH AVE NW STE 111 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730698358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053104211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EUBANKS | ||||||||
| AuthorizedOfficialFirstName: | AUDENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4052481229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 23705 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200065710A | 05 | OK | MEDICAID | 1306854765 | 01 | OK | INDIVIDUAL NPI | OTHER |