MEDICARE: DR. SCOTT CHRISTOPHER SCHULTZ MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019025883	IL
2	1223G0001X	General Practice Dentistry	2006013283	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588778831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT CHRISTOPHER SCHULTZ MD.

Provider Business Mailing Address
First Line	:	1835 KINGHIGHWAY
Second Line	:
City	:	WASHINGTON PARK
State	:	IL
Zip	:	62204
Country	:	US
Telephone Number	:	618-482-7922
Fax Number	:	618-482-7881

Provider Business Practice Location Address
First Line	:	1835 KINGSHIGHWAY
Second Line	:
City	:	WASHINGTON PARK
State	:	IL
Zip	:	62204
Country	:	US
Telephone Number	:	618-482-7922
Fax Number	:	618-482-7881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/30/2012

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