Provider Demographics
NPI:1386672046
Name:SCHULTZ, GEORG C (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORG
Middle Name:C
Last Name:SCHULTZ
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 1:5515 CLEVELAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:269-429-6604
Mailing Address - Fax:269-429-1715
Practice Address - Street 1:5515 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9670
Practice Address - Country:US
Practice Address - Phone:269-429-9644
Practice Address - Fax:269-429-4002
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3501108721OtherBLUE CROSS PIN
MI370004517OtherRAILROAD MEDICARE
MI2893951Medicaid
MIAS8333495OtherDEA
MIMI2051057Medicare PIN
MI3501108721OtherBLUE CROSS PIN
M35350018Medicare ID - Type Unspecified