Provider Demographics
NPI:1649261868
Name:SHULTZ, MICHAEL WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 STRUTHERS LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1949
Mailing Address - Country:US
Mailing Address - Phone:330-750-1333
Mailing Address - Fax:330-750-0203
Practice Address - Street 1:315 STRUTHERS LIBERTY RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1949
Practice Address - Country:US
Practice Address - Phone:330-750-1333
Practice Address - Fax:330-750-0203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004267S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
341563209OtherAETNA CLASS
34156320900OtherUNITED HEALTHCARE CLASS
000000133995OtherANTHEM SENIOR ADVANCE
0665169OtherOH WELFARE CLASS
000000133995OtherANTHEM CLASS
000000133995OtherANTHEM BENEFIT
60322OtherQUALCHOICE
080011301OtherRAILROAD MEDICARE
516931OtherHIGHMARK
516931OtherSELECT BLUE
000000133995OtherANTHEM FEP
0599322OtherMEDICARE CLASS
0102261OtherUHC OF COLUMBUS
OH0665169Medicaid
0599322OtherMEDICARE CLASS
516931OtherHIGHMARK