Provider Demographics
NPI:1699719625
Name:SCHULTZ, EDWARD V (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:V
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 1:7916 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4140
Mailing Address - Country:US
Mailing Address - Phone:260-434-6377
Mailing Address - Fax:260-434-6389
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2503
Practice Address - Country:US
Practice Address - Phone:260-824-0800
Practice Address - Fax:260-824-3207
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032069207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000670091OtherANTHEM
OH0659523Medicaid
IN100355420Medicaid
INP00916068OtherR.R. MEDICARE
IN925060YMedicare PIN
IN100355420Medicaid
INM400025563Medicare PIN
IN2347600005Medicare PIN