Basic Information
Provider Information
NPI: 1659309441
EntityType: 2
ReplacementNPI:  
OrganizationName: HEIDI SCHULTZ, M.D., P.A.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FULSHEAR FAMILY MEDICINE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 JEFFERSON ST STE 404
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705016991
CountryCode: US
TelephoneNumber: 2813460018
FaxNumber: 2813460913
Practice Location
Address1: 7629 TIKI DR
Address2:  
City: FULSHEAR
State: TX
PostalCode: 774411548
CountryCode: US
TelephoneNumber: 2813460018
FaxNumber: 2813460913
Other Information
ProviderEnumerationDate: 06/29/2006
LastUpdateDate: 02/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WAXALI
AuthorizedOfficialFirstName: ANISHA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2813460018
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 02/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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