Provider Demographics
NPI:1225141559
Name:SCHULZ, RICHARD KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KENNETH
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:STE 316
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3629
Mailing Address - Country:US
Mailing Address - Phone:866-607-2308
Mailing Address - Fax:248-855-5455
Practice Address - Street 1:818 W KING ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-723-3168
Practice Address - Fax:989-725-2962
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1754208600000X
MI5101013615208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225141559Medicaid
MI1225141559Medicaid
MI1225141559Medicaid
C56002089Medicare PIN
200C500040OtherBCBS OF MI
MEMM8664Medicare ID - Type Unspecified