Provider Demographics
NPI:1073776423
Name:SCHULTHEIS, RICHARD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:SCHULTHEIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 SUNNY LANE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-0000
Mailing Address - Country:US
Mailing Address - Phone:317-255-9087
Mailing Address - Fax:317-255-9149
Practice Address - Street 1:6704 SUNNY LANE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-0000
Practice Address - Country:US
Practice Address - Phone:317-255-9087
Practice Address - Fax:317-255-9149
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019118A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine