Provider Demographics
NPI:1760588297
Name:SHULTZ, SHERMAN (MD)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:800-551-7347
Mailing Address - Fax:
Practice Address - Street 1:580 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1543
Practice Address - Country:US
Practice Address - Phone:800-551-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033923207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4751982Medicaid
P00240381OtherRAILROAD MEDICARE
MID66167009Medicare ID - Type Unspecified
P00240381OtherRAILROAD MEDICARE