Healthcare Provider Details

I. General information

NPI: 1316938855
Provider Name (Legal Business Name): CRAIG A SCHULZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N LAKE DR SUITE G01
MILWAUKEE WI
53211-4528
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD ATTN: CSMCP CLINIC CREDENTIALING
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-1556
  • Fax: 414-291-1557
Mailing address:
  • Phone: 414-291-1556
  • Fax: 414-291-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number38117-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number38117-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: