Provider Demographics
NPI:1770563793
Name:SCHUTZ, LESLIE K (MD)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:K
Last Name:SCHUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:#3825
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4710
Mailing Address - Country:US
Mailing Address - Phone:989-631-9267
Mailing Address - Fax:989-839-0629
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:#3825
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4710
Practice Address - Country:US
Practice Address - Phone:989-631-9267
Practice Address - Fax:989-839-0629
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052628208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3383086Medicaid
MI3383086Medicaid
F38125Medicare UPIN