Provider Demographics
NPI:1669655460
Name:MELANIE D CLOONAN SCHULTE MD PC
Entity Type:Organization
Organization Name:MELANIE D CLOONAN SCHULTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLOONAN SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-821-9117
Mailing Address - Street 1:595 N DOBSON RD
Mailing Address - Street 2:SUITE D-76
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-821-0788
Mailing Address - Fax:480-821-0837
Practice Address - Street 1:595 N DOBSON RD
Practice Address - Street 2:SUITE D-76
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-821-0788
Practice Address - Fax:480-821-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ597148Medicaid
AZZ82160Medicare PIN
AZH52441Medicare UPIN