Healthcare Provider Details

I. General information

NPI: 1356562383
Provider Name (Legal Business Name): DANIEL L SCHOULTIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR ADMINISTRATION
DAYTON OH
45406-1813
US

IV. Provider business mailing address

2222 PHILADELPHIA DR ADMINISTRATION
DAYTON OH
45406-1813
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-6251
  • Fax: 937-223-9413
Mailing address:
  • Phone: 937-278-6251
  • Fax: 937-223-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-043835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: