Provider Demographics
NPI:1730534926
Name:SCHULTZ, KYLE ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ALEXANDER
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15360 HUNTING RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9095
Mailing Address - Country:US
Mailing Address - Phone:574-286-8636
Mailing Address - Fax:
Practice Address - Street 1:2310 CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1228
Practice Address - Country:US
Practice Address - Phone:574-264-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022238207X00000X
IN02006630A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery