Provider Demographics
NPI:1346378940
Name:LUETKEMEYER, ANNE FREY (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:FREY
Last Name:LUETKEMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVE
Mailing Address - Street 2:BOX 0874
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:415-476-4082
Mailing Address - Fax:415-476-6953
Practice Address - Street 1:995 POTRERO AVE
Practice Address - Street 2:BOX 0874
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-476-4082
Practice Address - Fax:415-476-6953
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74234207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH71329Medicare UPIN