Provider Demographics
NPI:1205884343
Name:LEMKE, JOHN A (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:LEMKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9396
Mailing Address - Country:US
Mailing Address - Phone:616-895-2000
Mailing Address - Fax:616-895-2009
Practice Address - Street 1:11315 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9396
Practice Address - Country:US
Practice Address - Phone:616-895-2000
Practice Address - Fax:616-895-2009
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4978771Medicaid
MIP08720004Medicare PIN
MI4978771Medicaid