MEDICARE: CARL SCHULTZ D.O.

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	207P00000X	Emergency Medicine Physician	OS6923	FL
2	207Q00000X	Family Medicine Physician	OS6923	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	221012	OTHER	FL	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5304033	OTHER	FL	AETNA
4	57143	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982669958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL SCHULTZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 SURFSIDE BLVD
Second Line	:	SUITE 200
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3821
Country	:	US
Telephone Number	:	239-541-7500
Fax Number	:	239-541-7501

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/18/2017

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