Provider Demographics
NPI:1598909541
Name:SCHEICK, LEWIS FREDERICK (IDMT)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:FREDERICK
Last Name:SCHEICK
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 E PARK AVE
Mailing Address - Street 2:APT. R-4
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5300
Mailing Address - Country:US
Mailing Address - Phone:269-589-7212
Mailing Address - Fax:
Practice Address - Street 1:23 MDG
Practice Address - Street 2:
Practice Address - City:MOODY A F B
Practice Address - State:GA
Practice Address - Zip Code:31699-0001
Practice Address - Country:US
Practice Address - Phone:229-257-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians