Healthcare Provider Details

I. General information

NPI: 1720570286
Provider Name (Legal Business Name): MEGAN SCHULTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 AVE MARIA DRIVE LOBBY A, SUITE 1200
ANN ARBOR MI
48105
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DRIVE 2130 TC
ANN ARBOR MI
48109-5340
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-6022
  • Fax: 734-998-6696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301115388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: