Provider Demographics
NPI:1740238542
Name:SCHULZ, MALCOLM A II (MD, FACS)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:A
Last Name:SCHULZ
Suffix:II
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2028
Mailing Address - Country:US
Mailing Address - Phone:618-498-3800
Mailing Address - Fax:618-498-8488
Practice Address - Street 1:400 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2028
Practice Address - Country:US
Practice Address - Phone:618-498-3800
Practice Address - Fax:618-498-8488
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070087532086S0127X, 208600000X
TXL9894174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170171601Medicaid
IL1740238542OtherINDIVIDUAL NPI
TXE63931Medicare UPIN
IL1740238542OtherINDIVIDUAL NPI