Healthcare Provider Details

I. General information

NPI: 1740238542
Provider Name (Legal Business Name): MALCOLM A SCHULZ II M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2028
US

IV. Provider business mailing address

400 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2028
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-3800
  • Fax: 618-498-8488
Mailing address:
  • Phone: 618-498-3800
  • Fax: 618-498-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9894
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2007008753
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2007008753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: