Provider Demographics
NPI:1831218981
Name:SCHULTHEIS, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:SCHULTHEIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG M STE #178
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-993-2622
Practice Address - Fax:602-993-2922
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12859208C00000X
AZ45977208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1831218981OtherBCBS
AZ709188Medicaid
AZ1831218981OtherMULTIPLAN/PHCS
AZ709188OtherCMPD
AZ1181953OtherCIGNA
AZ1045965OtherCOVENTRY
AZ1831218981OtherUHC
AZ7954905OtherAETNA
AZ1181953OtherCIGNA