Provider Demographics
NPI:1114928645
Name:SCHUETZ, PERRY N (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:N
Last Name:SCHUETZ
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 1:1422 POLK ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3619
Mailing Address - Country:US
Mailing Address - Phone:620-793-8414
Mailing Address - Fax:620-793-5923
Practice Address - Street 1:1422 POLK ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3619
Practice Address - Country:US
Practice Address - Phone:620-793-8414
Practice Address - Fax:620-793-5923
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15160KS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100086110AMedicaid
KS100086110AMedicaid
KS002547Medicare ID - Type Unspecified