Basic Information
| Provider Information | |||||||||
| NPI: | 1912947649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULARICK | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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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 | 2085R0202X | 27477 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1907907 | 01 | MN | AMERICA'S PPO | OTHER | P00186771 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 22136 | 05 | IA | MEDICAID | 1603148 | 01 | MN | MEDICA | OTHER | 34611600 | 05 | WI | MEDICAID | 392184100 | 05 | MN | MEDICAID | 412L0SC | 01 | MN | BLUE CROSS | OTHER | 412L1SC | 01 | MN | BLUE CROSS | OTHER | HP48698 | 01 | MN | HEALTHPARTNERS | OTHER | 1603134 | 01 | MN | MEDICA | OTHER | 960371042695 | 01 | MN | PREFERRED ONE | OTHER | 132517 | 01 | MN | UCARE | OTHER |