Provider Demographics
NPI:1053414631
Name:SCHULTZ, STEVEN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:EDWARD
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 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1601
Mailing Address - Country:US
Mailing Address - Phone:701-772-7263
Mailing Address - Fax:701-775-7245
Practice Address - Street 1:323 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1601
Practice Address - Country:US
Practice Address - Phone:701-772-7263
Practice Address - Fax:701-775-7245
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15971Medicaid
ND19842Medicare ID - Type Unspecified
D25598Medicare UPIN
MN340000962Medicare PIN