Provider Demographics
NPI:1336168905
Name:SCHULTE, CLAY D (MD)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:D
Last Name:SCHULTE
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 1:318 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1645
Mailing Address - Country:US
Mailing Address - Phone:218-546-2502
Mailing Address - Fax:218-546-4402
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1645
Practice Address - Country:US
Practice Address - Phone:218-546-2502
Practice Address - Fax:218-546-4402
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26305207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN503868500Medicaid
MN939000030Medicare ID - Type Unspecified
MN503868500Medicaid