| Doctor Name: | MR. MICHAEL SEVERIN SHULTIS |
| NPI Number: | 1013154038 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA60205742 |
| Business Practice Address: | 3911 Castlevale Rd Suite 301 Yakima, WA - 989027807 |
| Business Phone Number: | 5098347050 |
| Business Fax Number: | 5098347051 |
| Mailing Address: | 3911 Castlevale Rd, Suite 301 YAKIMA |
| State: | WA |
| Postal Code: | 989027807 |
| Phone Number: | 5098347050 |
| Fax Number: | 5098347051 |
| NPI Enumeration Date: | 01/13/2009 |
| NPI Last Update Date: | 03/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA60205742 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |