MEDICARE: DR. KENNETH ELLIOT SCHULTZ MD

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	207P00000X	Emergency Medicine Physician	24554	FL

General Provider Information

NPI Number	:	1538412028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ELLIOT SCHULTZ MD

Provider Business Mailing Address
First Line	:	150 W 9TH AVE
Second Line	:	APT. 4201
City	:	DENVER
State	:	CO
Zip	:	80204-4032
Country	:	US
Telephone Number	:	941-266-6174
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 W 9TH AVE
Second Line	:	APT. 4201
City	:	DENVER
State	:	CO
Zip	:	80204-4032
Country	:	US
Telephone Number	:	941-266-6174
Fax Number	:

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

Provider Enumeration Date	:	10/21/2012
Last Update Date	:	10/21/2012

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