Provider Demographics
NPI:1841298783
Name:SCHULTZ, LAURA L (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SCHULTZ
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 1:3955 PATIENT CARE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-1126
Practice Address - Street 1:3955 PATIENT CARE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:517-374-1126
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS036375207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI448678510Medicaid
MI0C36084014Medicare ID - Type Unspecified
MI448678510Medicaid