MEDICARE: DOUGLAS R SCHUCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	G058003	CA

General Provider Information

NPI Number	:	1457359622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS R SCHUCH M.D.

Provider Business Mailing Address
First Line	:	5301 F ST
Second Line	:	SUITE 111
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-452-8291
Fax Number	:	916-452-1733

Provider Business Practice Location Address
First Line	:	5301 F ST
Second Line	:	SUITE 111
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-452-8291
Fax Number	:	916-452-1733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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