Provider Demographics
NPI:1578560967
Name:SCHULTZ, MICHAEL JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 REISTERSTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2978
Mailing Address - Country:US
Mailing Address - Phone:410-469-5555
Mailing Address - Fax:410-469-4811
Practice Address - Street 1:1700 REISTERSTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2978
Practice Address - Country:US
Practice Address - Phone:410-469-5555
Practice Address - Fax:410-469-4811
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0014343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD318221500Medicaid
D74439Medicare UPIN