Provider Demographics
NPI:1851445332
Name:RALPH A. LEMCKE, MD, PC
Entity Type:Organization
Organization Name:RALPH A. LEMCKE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEMCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-296-6204
Mailing Address - Street 1:6542 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2117
Mailing Address - Country:US
Mailing Address - Phone:520-296-6204
Mailing Address - Fax:520-296-3463
Practice Address - Street 1:6542 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-296-6204
Practice Address - Fax:520-296-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7116207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ530718Medicaid
AZAZ0399330OtherBCBSAZ
AZAZ0399330OtherBCBSAZ
AZC99859Medicare UPIN