Provider Demographics
NPI:1316165632
Name:LUETKEMEYER, RICK C (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:C
Last Name:LUETKEMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:C
Other - Last Name:LUETKEMEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 NE ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61629-1410
Mailing Address - Country:US
Mailing Address - Phone:309-675-4687
Mailing Address - Fax:309-675-1076
Practice Address - Street 1:100 NE ADAMS ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61629-1410
Practice Address - Country:US
Practice Address - Phone:309-675-4687
Practice Address - Fax:309-675-1076
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-047245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine