Basic Information
| Provider Information | |||||||||
| NPI: | 1891735650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOEN-KIEWERT | ||||||||
| FirstName: | ERICH | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4854 PINOT ST | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329555162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142446488 | ||||||||
| FaxNumber: | 3212446488 | ||||||||
| Practice Location | |||||||||
| Address1: | 4854 PINOT ST | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329555162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212416800 | ||||||||
| FaxNumber: | 3212416888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | J8368 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | J8368 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME132651 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 023536500 | 05 | FL | MEDICAID | 8V1360 | 01 | TX | BLUE SHIELD NUMBER | OTHER |