Individual
MR. MICHAEL SEVERIN SHULTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
111 S 11TH AVE STE 320, YAKIMA, WA 98902-3273
(509) 454-8888
(509) 453-0061
Mailing address
PO BOX 2309, YAKIMA, WA 98907-2309
(509) 454-8888
(509) 453-0061
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60205742
WA
363AS0400X
Surgical Physician Assistant
PA60205742
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2011328
—
WA
Enumeration date
01/13/2009
Last updated
01/26/2023
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