Healthcare Provider Details

I. General information

NPI: 1962804542
Provider Name (Legal Business Name): MR. ERIC SCHULTHEIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ERIC SCHULTHEIS 4TH.YR. MS

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 AVENUE E
MARRERO LA
70072-1925
US

IV. Provider business mailing address

623 AVENUE E
MARRERO LA
70072-1925
US

V. Phone/Fax

Practice location:
  • Phone: 504-957-7569
  • Fax:
Mailing address:
  • Phone: 504-957-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: