Provider Demographics
NPI:1316938855
Name:SCHULZ, CRAIG A (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-291-1556
Mailing Address - Fax:414-291-1557
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE G01
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-291-1556
Practice Address - Fax:414-291-1557
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38117-0202085R0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32638900Medicaid
WI920005881OtherRAILROAD MEDICARE
WI920005881OtherRAILROAD MEDICARE
WI000302104Medicare ID - Type Unspecified
WI920005881OtherRAILROAD MEDICARE
WI000660165Medicare ID - Type Unspecified
WI32638900Medicaid