Provider Demographics
NPI:1558323816
Name:SCHULZ, THOMAS KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:KEVIN
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-2262
Mailing Address - Fax:909-558-0304
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-2262
Practice Address - Fax:909-558-0304
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9070207R00000X, 207RH0003X
KS0424742207RH0003X
CAG174921207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1286700007OtherDMERC REGION ONE
1286700008OtherDMERC REGION ONE
1286700005OtherDMERC REGION ONE
AR207213001Medicaid
1286700006OtherDMERC REGION ONE
1286700012OtherDMERC REGION ONE
1286700004OtherDMERC REGION ONE
1286700013OtherDMERC REGION ONE
1286700011OtherDMERC REGION ONE
1286700002OtherDMERC REGION ONE
12867010010OtherDMERC REGION ONE
1286700015OtherDMERC REGION ONE
KS100178780BMedicaid
1286700003OtherDMERC REGION ONE
1286700009OtherDMERC REGION ONE
1286700007OtherDMERC REGION ONE
1286700008OtherDMERC REGION ONE
AR399938YJJGMedicare PIN