Basic Information
| Provider Information | |||||||||
| NPI: | 1851409098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2104 NORTHDALE BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554333028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635376000 | ||||||||
| FaxNumber: | 7635376666 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 FRANCE AVE S STE 100 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635376000 | ||||||||
| FaxNumber: | 7635376666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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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 | 208M00000X | 32916 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | G68677 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208VP0014X | 32916 | MN | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207R00000X | 32916 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G686770 | 05 | CA | MEDICAID | G68677 | 01 | CA | STATE LICENSE | OTHER |