Healthcare Provider Details

I. General information

NPI: 1801316096
Provider Name (Legal Business Name): COLLIN MARK SCHULTZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/25/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 N EVERGREEN DR NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

100 MICHIGAN ST NE STE A601
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7225
  • Fax: 616-495-7271
Mailing address:
  • Phone: 616-391-6243
  • Fax: 616-391-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number5151015627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: