MEDICARE: CHARLES WILLIAM SCHILDECKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME 31641	FL

General Provider Information

NPI Number	:	1467480301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES WILLIAM SCHILDECKER M.D.

Provider Business Mailing Address
First Line	:	401 DOWNING ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7109
Country	:	US
Telephone Number	:	386-428-3243
Fax Number	:	386-428-9929

Provider Business Practice Location Address
First Line	:	401 DOWNING ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7109
Country	:	US
Telephone Number	:	386-428-3243
Fax Number	:	386-428-9929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	12/17/2012

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