Provider Demographics
NPI:1881640241
Name:SCHULTZ, GREG A (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-7180
Mailing Address - Fax:605-328-7177
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-3350
Practice Address - Fax:605-328-3351
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD16842086S0129X
MN260212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS41252Medicare PIN
MN020001682Medicare PIN