Provider Demographics
NPI:1255351623
Name:SHULTZ, WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:105 BRUCE PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE D
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8504
Mailing Address - Country:US
Mailing Address - Phone:859-498-0082
Mailing Address - Fax:859-215-0329
Practice Address - Street 1:105 BRUCE PROFESSIONAL PLZ
Practice Address - Street 2:SUITE D
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-8504
Practice Address - Country:US
Practice Address - Phone:859-498-0082
Practice Address - Fax:859-215-0329
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY02328207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000215567OtherANTHEM
KY50005448OtherPASSPORT
KY64023286Medicaid
KY930114901OtherRR-MEDICARE
KY000000215567OtherANTHEM
KY64023286Medicaid