Provider Demographics
NPI:1316939325
Name:BALTZ, CURTIS COULTER (MD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:COULTER
Last Name:BALTZ
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 1:122 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5794
Mailing Address - Country:US
Mailing Address - Phone:920-996-3264
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:333 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1954
Practice Address - Country:US
Practice Address - Phone:920-725-2070
Practice Address - Fax:920-725-4549
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19944207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV19944OtherSTATE LICENSE
WI110034806OtherRR MEDICARE
WV52D0671586OtherCLIA
WI31232600Medicaid
WIAB7052195OtherDEA
WV52D0671586OtherCLIA
WIB51342Medicare UPIN