Provider Demographics
NPI:1184643736
Name:SCHULTIS, ERIC J (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:SCHULTIS
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 1:4224 HOUMA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2934
Mailing Address - Country:US
Mailing Address - Phone:504-455-7999
Mailing Address - Fax:504-455-7920
Practice Address - Street 1:4720 S. I-10 SERVICE RD. W
Practice Address - Street 2:SUITE 206
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1240
Practice Address - Country:US
Practice Address - Phone:504-455-7999
Practice Address - Fax:504-455-7920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD104207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA160009039OtherRR MEDICAF
LA1337323Medicaid
LA423022231AOtherBC/BS OF LA
LA690471OtherAETNA