Provider Demographics
NPI:1629020037
Name:SCHLUETER, ERIC M (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:SCHLUETER
Suffix:
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:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:
Practice Address - Street 1:1228 HARDEN ST
Practice Address - Street 2:EAU CLAIRE COOPERATIVE HEALTH CENTERS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1800
Practice Address - Country:US
Practice Address - Phone:803-733-5969
Practice Address - Fax:803-748-9953
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC030Medicaid
SCFQC043Medicaid
SC7131Medicare ID - Type UnspecifiedLOCAL
WI421892Medicare ID - Type Unspecified
SCH19846Medicare UPIN
WI421832Medicare ID - Type Unspecified
SCFQC043Medicaid