Healthcare Provider Details

I. General information

NPI: 1922211341
Provider Name (Legal Business Name): MARK SCHULKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17014 W BELL RD STE 100
SURPRISE AZ
85374-2479
US

IV. Provider business mailing address

17014 W BELL RD STE 100
SURPRISE AZ
85374-2479
US

V. Phone/Fax

Practice location:
  • Phone: 888-405-6396
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-405-6396
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33860
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: