=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356562383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL L SCHOULTIES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 PHILADELPHIA DR ADMINISTRATION
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-278-6251
-----------------------------------------------------
Fax | 937-223-9413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 PHILADELPHIA DR ADMINISTRATION
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-278-6251
-----------------------------------------------------
Fax | 937-223-9413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35-043835
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------