Provider Demographics
NPI:1780735340
Name:SCHUTT, SHANE A (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:A
Last Name:SCHUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8005 FARNAM DR
Mailing Address - Street 2:STE 305
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3426
Mailing Address - Country:US
Mailing Address - Phone:402-390-4111
Mailing Address - Fax:402-399-8455
Practice Address - Street 1:222 N 192ND ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-5363
Practice Address - Country:US
Practice Address - Phone:402-390-4111
Practice Address - Fax:402-390-4115
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-06441207X00000X
IDM10971207X00000X
NE25923207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780735340Medicaid
NE47068731751Medicaid
NE47068731742Medicaid
NE099099112Medicare PIN