Healthcare Provider Details

I. General information

NPI: 1164418794
Provider Name (Legal Business Name): SUSAN K SCHULTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-725-2000
  • Fax: 612-794-3990
Mailing address:
  • Phone: 612-725-2000
  • Fax: 612-794-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number135218
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number135218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: