Provider Demographics
NPI:1629022116
Name:SCHLICKMAN, LOUIS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MICHAEL
Last Name:SCHLICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 E GENTRY WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3013
Mailing Address - Country:US
Mailing Address - Phone:208-884-3770
Mailing Address - Fax:541-278-8360
Practice Address - Street 1:3080 E GENTRY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3013
Practice Address - Country:US
Practice Address - Phone:208-884-3770
Practice Address - Fax:541-278-8360
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00191484OtherRAILROAD MEDICARE
ID805294800Medicaid
ID201188708OtherCHAMPUS
IDP00191484OtherRAILROAD MEDICARE
ID1139459Medicare ID - Type Unspecified