Provider Demographics
NPI:1215044334
Name:LEMBCKE, DANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:LEMBCKE
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 1:712 SOUTH CASCADE STREET
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2813
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-736-8757
Practice Address - Street 1:712 SOUTH CASCADE STREET
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2813
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-736-8757
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-00795OtherMEDICA FFMG NUMBER
MN01-09270OtherMEDICA BLC NUMBER
IA0582585Medicaid
ND13383Medicaid
MN736577200Medicaid
NE41091744413Medicaid
MN09454LEOtherBCBS NUMBER
MN110684OtherU-CARE NUMBER
MN1008791OtherPREFERRED ONE NUMBER
MNHP26729OtherHEALTHPARTNERS NUMBER
MN089004559Medicare ID - Type UnspecifiedMEDICARE FFMG NUMBER
MND86721Medicare UPIN
MN09454LEOtherBCBS NUMBER
MN01-09270OtherMEDICA BLC NUMBER
MN736577200Medicaid