MEDICARE: DR. STACY NORMAN SCHULZ 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	207R00000X	Internal Medicine Physician	2604	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2604	OTHER	AK	STATE MD LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851303903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY NORMAN SCHULZ MD

Provider Business Mailing Address
First Line	:	PO BOX 6755
Second Line	:	212 CARLANNA RD #201
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-1755
Country	:	US
Telephone Number	:	907-247-3301
Fax Number	:	907-247-3306

Provider Business Practice Location Address
First Line	:	212 CARLANNA LAKE RD STE 201
Second Line	:	BOX 6755
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5642
Country	:	US
Telephone Number	:	907-247-3301
Fax Number	:	907-247-3306

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	10/17/2007

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