Provider Demographics
NPI:1760477210
Name:SHULTZ, KIRKWOOD TANNER (MD)
Entity type:Individual
Prefix:DR
First Name:KIRKWOOD
Middle Name:TANNER
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5388
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-5388
Mailing Address - Country:US
Mailing Address - Phone:800-277-8151
Mailing Address - Fax:
Practice Address - Street 1:19900 W CATAWBA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4032
Practice Address - Country:US
Practice Address - Phone:800-277-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3870207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976095Medicaid
NCP00095122OtherRAILROAD MEDICARE
NCC86437Medicare UPIN
NC8976095Medicaid