Provider Demographics
NPI:1962437590
Name:SEMMES, LUETTE S (MD)
Entity type:Individual
Prefix:
First Name:LUETTE
Middle Name:S
Last Name:SEMMES
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:106 MILFORD ST STE 301
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6962
Practice Address - Country:US
Practice Address - Phone:410-546-4431
Practice Address - Fax:410-543-8259
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039545174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD064951100Medicaid
MDK441X800Medicare ID - Type Unspecified
MD064951100Medicaid