Provider Demographics
NPI:1093713240
Name:SCHULTHEIS, DENNIE L (MD)
Entity Type:Individual
Prefix:
First Name:DENNIE
Middle Name:L
Last Name:SCHULTHEIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 TURNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1508
Mailing Address - Country:US
Mailing Address - Phone:707-845-1846
Mailing Address - Fax:
Practice Address - Street 1:3946 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3300
Practice Address - Country:US
Practice Address - Phone:916-737-5555
Practice Address - Fax:877-860-2907
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A603370Medicaid
CA00A603370Medicare ID - Type Unspecified
CA00A603370Medicaid