Provider Demographics
NPI:1538239454
Name:SCHULZE, KENNETH WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:SCHULZE
Suffix:JR
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 1:2012 W ELM STREET
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301
Mailing Address - Country:US
Mailing Address - Phone:307-324-6022
Mailing Address - Fax:307-324-3835
Practice Address - Street 1:2012 W ELM STREET
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-324-6022
Practice Address - Fax:307-324-3835
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5186A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106366900Medicaid
WY101847700Medicaid
WY00972001OtherBLUE CROSS BLUE SHIELD
WY20012453OtherRR MEDICARE
WY836000025-24OtherTRICARE
WY106366900Medicaid
WY836000025-24OtherTRICARE
WYW306426Medicare ID - Type Unspecified