Provider Demographics
NPI:1922003466
Name:SHULSKI, FRED PAUL JR (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:PAUL
Last Name:SHULSKI
Suffix:JR
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 1:4700 N 51ST AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1237
Mailing Address - Country:US
Mailing Address - Phone:623-846-7575
Mailing Address - Fax:623-247-6386
Practice Address - Street 1:4700 N 51ST AVE
Practice Address - Street 2:STE 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1237
Practice Address - Country:US
Practice Address - Phone:623-846-7575
Practice Address - Fax:623-247-6386
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29140208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ564585Medicaid
AZ1200614OtherUNITED HEALTHCARE
AZ1Z8751OtherHEALTHNET
AZ85031A011OtherTRICARE
AZAZ0885580OtherBCBS