Provider Demographics
NPI:1477707404
Name:LUEM, CARL DOMINICK (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:DOMINICK
Last Name:LUEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:LUEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 295W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7504
Mailing Address - Country:US
Mailing Address - Phone:406-238-6360
Mailing Address - Fax:406-238-6361
Practice Address - Street 1:2900 12TH AVE N STE 295W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-238-6360
Practice Address - Fax:406-238-6361
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8790853-1205207ZP0102X
ORLL18028390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program