Provider Demographics
NPI:1639461007
Name:LUEPKE, GWEN GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:GEORGE
Last Name:LUEPKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:KAY
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4612 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3795
Mailing Address - Country:US
Mailing Address - Phone:515-252-1421
Mailing Address - Fax:
Practice Address - Street 1:2725 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1134
Practice Address - Country:US
Practice Address - Phone:515-279-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine