Provider Demographics
NPI:1831227560
Name:SCHULTHEISS, KIM EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:EVELYN
Last Name:SCHULTHEISS
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 1:322 E CENTRAL BLVD
Mailing Address - Street 2:UNIT 1009
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4324
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-219-2627
Practice Address - Fax:770-219-2627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087089174400000X
IL036113869207RC0200X
WAMD604298312086S0102X
VAMD604298312086S0102X
GA0743542086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36113869OtherILLINIOS LICENSE
WAMD60429831OtherPROFESSIONAL LICENSE
MI4301087089OtherMICHIGAN LICENSE
PAMD425491OtherPENNSYLVANIA LICENSE