Individual
DR. STANTON G SCHULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
416 NORTH 12TH STREET, SOUTHERN ILLINOIS CONSULTANTS FOR KIDNEY DISEASE, S.C., MT. VERNON, IL 62864-4314
(618) 244-4850
(618) 244-7985
Mailing address
P.O. BOX 1704, 416 NORTH 12TH STREET, MT. VERNON, IL 62864-0034
(618) 244-4850
(618) 244-7985
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
1027161
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246480
—
IN
01
—
390004295
RAILROAD MEDICARE
IN
Enumeration date
07/28/2005
Last updated
07/22/2009
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