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General NPI Number Information
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NPI Number | 1619921202
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Entity Type | Organization
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Legal Business Name | MERIDIAN ADULT MEDICINE, PLLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD SUITE 1221
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-884-3770
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Fax | 208-884-5602
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Provider Business Mailing Address
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Address Line | 520 S EAGLE RD SUITE 1221
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-884-3770
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Fax | 208-884-5602
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOUIS MICHAEL SCHLICKMAN
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Credential | M.D.
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Telephone | 208-884-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M7522
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License Number State | ID
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