Michelle A Lueck, PA-C – Medical Physician Assistant

Key facts

NPI: 1366469033
Entity type: Individual (NPI type 1)
Primary specialty: Medical Physician Assistant 363AM0700X
License: PAC0150 (ND)
Practice address: 201 4TH Ave
Enderlin, ND 58027-1325
Phone: (701) 437-3320
Fax: (701) 437-3323
NPI assigned: Jul 17, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Sanford Medical Center Fargo Family Medicine Physician · West Fargo, ND · NPI 1184917924

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

Practice roles

Organization	Specialty	Status	New patients
Sanford Medical Center Fargo		Current	Accepting new patients

Locations

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medical Physician Assistant	363AM0700X	PAC0150	ND	Yes

Addresses

Primary practice location

201 4TH Ave
Enderlin, ND 58027-1325

Mailing address

201 4TH Ave
Enderlin, ND 58027-1325
Phone (701) 437-3320

Other identifiers

Identifier	Type	State	Issuer
012890200	Medicaid	MN
71086	Medicaid	ND

Other providers in Enderlin, ND

All providers in Enderlin, ND · Medical Physician Assistant in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.