Provider Demographics
NPI:1386646214
Name:SCHULTZ, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 BREMO RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2442
Mailing Address - Country:US
Mailing Address - Phone:804-239-1640
Mailing Address - Fax:804-239-1655
Practice Address - Street 1:2004 BREMO RD
Practice Address - Street 2:SUITE 207
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2442
Practice Address - Country:US
Practice Address - Phone:804-239-1640
Practice Address - Fax:804-239-1655
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241224207Q00000X
OH35-051517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0840684Medicaid
VA1386646214Medicaid
OH35-051517OtherSTATE MEDICAL LICENSE
C33903Medicare UPIN
SC0703651Medicare ID - Type UnspecifiedMEDICARE