Provider Demographics
NPI:1043247711
Name:SCHULTE, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:FURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-431-0090
Mailing Address - Fax:859-431-3168
Practice Address - Street 1:119 FAIRFIELD AVE
Practice Address - Street 2:SUITE R102
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1184
Practice Address - Country:US
Practice Address - Phone:859-431-0090
Practice Address - Fax:859-431-3168
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00840874OtherRAILROAD MEDICARE
OH0101268Medicaid
KY080092528OtherRAILROAD MEDICARE
KY64230170Medicaid
KY64230170Medicaid
KY080092528OtherRAILROAD MEDICARE
KY0387607Medicare PIN