Provider Demographics
NPI:1245349257
Name:LUEPKER, RUSSELL VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:VINCENT
Last Name:LUEPKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 2ND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1075
Mailing Address - Country:US
Mailing Address - Phone:612-624-6362
Mailing Address - Fax:612-624-0315
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-624-6362
Practice Address - Fax:612-624-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23175282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNAL3085809OtherDEA REGISTRATION NUMBER