Healthcare Provider Details

I. General information

NPI: 1982848503
Provider Name (Legal Business Name): SANDRA JOANNE SCHULTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12142 BUSINESS PARK BLVD N
CHAMPLIN MN
55316-4525
US

IV. Provider business mailing address

12142 BUSINESS PARK BLVD N
CHAMPLIN MN
55316-4525
US

V. Phone/Fax

Practice location:
  • Phone: 952-977-0500
  • Fax: 952-977-0510
Mailing address:
  • Phone: 952-977-0500
  • Fax: 952-977-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55778
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55778
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: