Healthcare Provider Details

I. General information

NPI: 1235129743
Provider Name (Legal Business Name): MATTHEW D SCHULTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S. HWY 65
MORA MN
55051
US

IV. Provider business mailing address

301 HIGHWAY 65 S
MORA MN
55051-1899
US

V. Phone/Fax

Practice location:
  • Phone: 320-679-1212
  • Fax:
Mailing address:
  • Phone: 320-679-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48320
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53749
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: