MEDICARE: IAN SCHULTHEISS

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	390200000X	Student in an Organized Health Care Education/Training Program		TN

General Provider Information

NPI Number	:	1649749169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN SCHULTHEISS

Provider Business Mailing Address
First Line	:	1616 W MAIN ST STE 201
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3192
Country	:	US
Telephone Number	:	615-421-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 W MAIN ST STE 201
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3192
Country	:	US
Telephone Number	:	615-421-4626
Fax Number	:

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

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	06/09/2026

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Directions to “ IAN SCHULTHEISS ” Practice Location

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