Doctor Name: | MR. JACOB SCHULTZ |
NPI Number: | 1497125090 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ATC |
License Number: | S4324369313404 |
Business Practice Address: | 5048 Coopers Landing Dr Apt 2b Kalamazoo, MI - 490046658 |
Business Phone Number: | 9209179600 |
Business Fax Number: | |
Mailing Address: | 5048 Coopers Landing Dr Apt 2b, KALAMAZOO |
State: | MI |
Postal Code: | 490046658 |
Phone Number: | 9209179600 |
Fax Number: | |
NPI Enumeration Date: | 09/25/2015 |
NPI Last Update Date: | 09/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | S4324369313404 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |