Provider Demographics
NPI:1538412028
Name:SCHULTZ, KENNETH ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ELLIOT
Last Name:SCHULTZ
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 1:150 W 9TH AVE
Mailing Address - Street 2:APT. 4201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4032
Mailing Address - Country:US
Mailing Address - Phone:941-266-6174
Mailing Address - Fax:
Practice Address - Street 1:150 W 9TH AVE
Practice Address - Street 2:APT. 4201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4032
Practice Address - Country:US
Practice Address - Phone:941-266-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24554207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine