Provider Demographics
NPI:1922211341
Name:SCHULKE, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHULKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14506 W GRANITE VALLEY DR STE 123
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6012
Mailing Address - Country:US
Mailing Address - Phone:623-250-2150
Mailing Address - Fax:623-250-2450
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 123
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6012
Practice Address - Country:US
Practice Address - Phone:623-250-2150
Practice Address - Fax:623-250-2450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ33860207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine