Provider Demographics
NPI:1982678090
Name:SCHULTZ, CHARLES C (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 CANTERBURY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2247
Mailing Address - Country:US
Mailing Address - Phone:785-623-5945
Mailing Address - Fax:785-623-5949
Practice Address - Street 1:2500 CANTERBURY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2247
Practice Address - Country:US
Practice Address - Phone:785-623-5945
Practice Address - Fax:785-623-5949
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-22281208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE57633Medicare UPIN
KS105261Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #