Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 34079 | MN |
NPI | 1003893520 |
---|---|
Provider Name | Jeffrey J Shultz |
First Address | St Louis Park, MN 55426-1728 |
Second Address | St Louis Park, MN 55426-4702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 05/10/2011 |