Provider Demographics
NPI:1336931740
Name:SCHULTHEIS, CARLIE GRACE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:GRACE
Last Name:SCHULTHEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 SIMIEN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3061
Mailing Address - Country:US
Mailing Address - Phone:317-903-1332
Mailing Address - Fax:
Practice Address - Street 1:1550 E COUNTY LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0990
Practice Address - Country:US
Practice Address - Phone:317-497-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant