Healthcare Provider Details

I. General information

NPI: 1831218981
Provider Name (Legal Business Name): MARY E. SCHULTHEIS MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE BLDG M STE #178
GLENDALE AZ
85308-1260
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-2622
  • Fax: 602-993-2922
Mailing address:
  • Phone: 602-258-9900
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number12859
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number45977
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: