Provider Demographics
NPI:1023184694
Name:SCHULZ, GORDON ANTHONY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ANTHONY
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20121 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1009
Practice Address - Country:US
Practice Address - Phone:708-756-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042090A103TC0700X
IL071005343103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0090001287OtherBLUE CROSS BLUE SHIELD
IL4673170001OtherDMERC GROUP
ILP00439470/CK6882OtherRAILROAD MEDICARE
ILIL5686039OtherMEDICARE PTAN
ILK46135/203980Medicare PIN
ILK46134/203979Medicare PIN