Provider Demographics
NPI:1902484249
Name:JUSTIN P SCHULTZ DO PC
Entity Type:Organization
Organization Name:JUSTIN P SCHULTZ DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:WORISCHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-897-2727
Mailing Address - Street 1:6007 E BASELINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4801
Mailing Address - Country:US
Mailing Address - Phone:480-897-2727
Mailing Address - Fax:480-892-3035
Practice Address - Street 1:6007 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4801
Practice Address - Country:US
Practice Address - Phone:480-897-2727
Practice Address - Fax:480-892-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty