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Organization

MERIDIAN ADULT MEDICINE, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LOUIS MICHAEL SCHLICKMAN M.D. (OWNER)
(208) 884-3770
Entity
Organization

Contact information

Practice address
520 S EAGLE RD, SUITE 1221, MERIDIAN, ID 83642-6351
(208) 884-3770
(208) 884-5602
Mailing address
520 S EAGLE RD, SUITE 1221, MERIDIAN, ID 83642-6351
(208) 884-3770
(208) 884-5602

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M7522
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8J810
BLUE CROSS GROUP
ID
01
DC8105
RAILROAD MEDICARE GROUP
ID
Enumeration date
05/19/2006
Last updated
07/12/2007
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