Healthcare Provider Details

I. General information

NPI: 1437357936
Provider Name (Legal Business Name): WILLIAM ROBERT SHULTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NORTH MERIDIAN STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1901 NORTH MERIDIAN STREET
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-2200
  • Fax: 317-405-9237
Mailing address:
  • Phone: 317-925-2200
  • Fax: 317-921-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number54563-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01071460A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: