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General NPI Number Information
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NPI Number | 1942831086
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Entity Type | Individual
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Provider Name | GREGORY Q SCHULTZ LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 1531 S MADISON ST FL 4
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City | APPLETON
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State | WI
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Zip | 54915-1800
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Country | US
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Telephone | 920-840-0552
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Fax |
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Provider Business Mailing Address
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Address Line | N470 MAPLERIDGE DR
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City | APPLETON
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State | WI
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Zip | 54915-8753
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Country | US
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Telephone | 920-840-0552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 2139-39
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License Number State | WI
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