Basic Information
| Provider Information | |||||||||
| NPI: | 1922211341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULKE | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 E BELL RD | ||||||||
| Address2: | STE 2200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026333848 | ||||||||
| FaxNumber: | 6026333841 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239354700 | ||||||||
| FaxNumber: | 6239354707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 12809 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 33860 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.