Provider Demographics
NPI:1952331605
Name:KIMBERLY K. SCHULZ
Entity Type:Organization
Organization Name:KIMBERLY K. SCHULZ
Other - Org Name:TOWN SQUARE DERMATOLOGY, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-4566
Mailing Address - Street 1:1100 6TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1755
Mailing Address - Country:US
Mailing Address - Phone:319-337-4566
Mailing Address - Fax:
Practice Address - Street 1:1100 6TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1755
Practice Address - Country:US
Practice Address - Phone:319-337-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32786207N00000X
IA31541207N00000X
IA001292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0466557Medicaid
IA14-77506814OtherNPI -WALLING
IAI20222OtherPTAN
IA2208108Medicaid
IA0497545Medicaid
IA12-25017718OtherNPI -SCHULZ
IA17-30128653OtherNPI - ROBSON
IA18-11967219OtherNPI - MCKEE
IAP07714Medicare UPIN
IA14-77506814OtherNPI -WALLING
IAG18304Medicare UPIN
IAI34948Medicare UPIN
IAI11551Medicare PIN