Provider Demographics
NPI:1720070139
Name:LEMBERGER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LEMBERGER
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 1:611 E 2ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-6010
Mailing Address - Country:US
Mailing Address - Phone:509-822-7395
Mailing Address - Fax:509-822-7392
Practice Address - Street 1:611 E 2ND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-6010
Practice Address - Country:US
Practice Address - Phone:509-822-7395
Practice Address - Fax:509-822-7392
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018979207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8174245Medicaid
WAG8952716Medicare PIN
WA8174245Medicaid