Provider Demographics
NPI:1275688798
Name:SCHULMAN, JEFFREY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:SCHULMAN
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 1:755 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8703
Mailing Address - Country:US
Mailing Address - Phone:314-432-2428
Mailing Address - Fax:
Practice Address - Street 1:755 S NEW BALLAS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8703
Practice Address - Country:US
Practice Address - Phone:314-432-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR64842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE56759Medicare UPIN