Provider Demographics
NPI:1396738316
Name:LUEBKE, MARLYS (MD)
Entity type:Individual
Prefix:DR
First Name:MARLYS
Middle Name:
Last Name:LUEBKE
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:SD
Mailing Address - Zip Code:57328-0022
Mailing Address - Country:US
Mailing Address - Phone:605-946-5332
Mailing Address - Fax:
Practice Address - Street 1:708 8TH ST
Practice Address - Street 2:
Practice Address - City:ARMOUR
Practice Address - State:SD
Practice Address - Zip Code:57313-2102
Practice Address - Country:US
Practice Address - Phone:605-724-2151
Practice Address - Fax:605-724-2310
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
SD1922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5605095Medicaid
SD0001584OtherBLUE CROSS
SD20287OtherSIOUX VALLEY HEALTH PLAN
SD20287OtherSIOUX VALLEY HEALTH PLAN
SD5605095Medicaid