Provider Demographics
NPI:1972867844
Name:LEHRKE, HEIDI DAWN (DO)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DAWN
Last Name:LEHRKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 10TH AVE S STE 2200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1311
Mailing Address - Country:US
Mailing Address - Phone:612-767-8370
Mailing Address - Fax:612-767-8376
Practice Address - Street 1:2800 10TH AVE S STE 2200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-767-8370
Practice Address - Fax:612-767-8376
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56618207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN56618OtherMINNESOTA MEDICAL LICENSE