Provider Demographics
NPI:1659309441
Name:HEIDI SCHULTZ, M.D., P.A.
Entity Type:Organization
Organization Name:HEIDI SCHULTZ, M.D., P.A.
Other - Org Name:FULSHEAR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-346-0018
Mailing Address - Street 1:600 JEFFERSON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6991
Mailing Address - Country:US
Mailing Address - Phone:281-346-0018
Mailing Address - Fax:281-346-0913
Practice Address - Street 1:7629 TIKI DR
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1548
Practice Address - Country:US
Practice Address - Phone:281-346-0018
Practice Address - Fax:281-346-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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