Provider Demographics
NPI:1437244621
Name:LEMKE, BRADLEY NATHANAEL (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:NATHANAEL
Last Name:LEMKE
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 1:1200 JOHN Q HAMMONS DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717
Mailing Address - Country:US
Mailing Address - Phone:608-829-7777
Mailing Address - Fax:608-829-7778
Practice Address - Street 1:1200 JOHN Q HAMMONS DR
Practice Address - Street 2:STE 101
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717
Practice Address - Country:US
Practice Address - Phone:608-829-7777
Practice Address - Fax:608-829-7778
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20222020207W00000X
IL036111560207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30337700Medicaid
IL211192OtherMEDICARE CMS WPS STATE OF
IL211192OtherMEDICARE CMS WPS STATE OF
WI03001Medicare ID - Type UnspecifiedADAMS FRIENDSHIP
WI30337700Medicaid
WI44012Medicare ID - Type UnspecifiedWOODRUFF
WI71117Medicare ID - Type UnspecifiedOSHKOSH