Provider Demographics
NPI:1891709531
Name:KEMPKE, SEAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:KEMPKE
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 1:4855 W. ARROWHEAD ROAD
Mailing Address - Street 2:DULUTH CLINIC-HERMANTOWN
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-786-3540
Mailing Address - Fax:
Practice Address - Street 1:4855 W. ARROWHEAD ROAD
Practice Address - Street 2:DULUTH CLINIC-HERMANTOWN
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-786-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0125489OtherMEDICA
MN813470000Medicaid
162H6KEOtherBCBSMN
P00440551OtherRR MEDICARE PTAN
0125489OtherMEDICA
080015223Medicare ID - Type Unspecified