Provider Demographics
NPI:1770598427
Name:SHULTZ PIATZ, KINSEY A (MD)
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:A
Last Name:SHULTZ PIATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8134
Mailing Address - Country:US
Mailing Address - Phone:605-719-7313
Mailing Address - Fax:605-719-7333
Practice Address - Street 1:2920 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8134
Practice Address - Country:US
Practice Address - Phone:605-719-7313
Practice Address - Fax:605-719-7333
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10907207Q00000X
IA36783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336127828OtherGROUP NPI
IA0744748Medicaid
I21172Medicare PIN
IAI65119Medicare PIN