Provider Demographics
NPI:1356331011
Name:SCHUT, LAWRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:SCHUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 295
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6688
Mailing Address - Fax:612-626-3217
Practice Address - Street 1:516 DELAWARE ST SE CLINIC 1A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6688
Practice Address - Fax:612-626-3217
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-02-25
Deactivation Date:2014-12-04
Deactivation Code:
Reactivation Date:2016-02-10
Provider Licenses
StateLicense IDTaxonomies
MN163002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93944Medicare UPIN
0500047OtherMEDICA HEALTH PLANS
104540OtherU-CARE
13R40SCOtherBLUE CROSS BLUE SHIELD
256916OtherPREFERRED ONE
HP14351OtherHEALTH PARTNERS
2114061OtherFIRST HEALTH PLAN
992870700OtherMEDICAL ASSISTANCE
A93944Medicare UPIN
130000810OtherMEDICARE