Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 17779 | MN |
NPI | 1457560708 |
---|---|
Provider Name | Jerome E Schulz |
First Address | Plymouth, MN 55441-2304 |
Second Address | Plymouth, MN 55441-2304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |