Provider Demographics
NPI:1912947649
Name:SCHULARICK, MARTIN W (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:SCHULARICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN274772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1907907OtherAMERICA'S PPO
MNP00186771OtherRAILROAD MEDICARE MN
IA22136Medicaid
MN1603148OtherMEDICA
WI34611600Medicaid
MN392184100Medicaid
MN412L0SCOtherBLUE CROSS
MN412L1SCOtherBLUE CROSS
MNHP48698OtherHEALTHPARTNERS
MN1603134OtherMEDICA
MN960371042695OtherPREFERRED ONE
MN132517OtherUCARE
MNHP48698OtherHEALTHPARTNERS
MN412L1SCOtherBLUE CROSS
MN300003571Medicare PIN
MNP00186771OtherRAILROAD MEDICARE MN
MN412L0SCOtherBLUE CROSS
IA22136Medicaid