Provider Demographics
NPI:1356562383
Name:SCHOULTIES, DANIEL L (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:SCHOULTIES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2222 PHILADELPHIA DR
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1813
Mailing Address - Country:US
Mailing Address - Phone:937-278-6251
Mailing Address - Fax:937-223-9413
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1813
Practice Address - Country:US
Practice Address - Phone:937-278-6251
Practice Address - Fax:937-223-9413
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-043835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC01980Medicare UPIN