Provider Demographics
NPI:1144454679
Name:GRUPKE, STEPHEN LUKE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LUKE
Last Name:GRUPKE
Suffix:
Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:2215 NASHVILLE AVE # MS 106
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:859-257-8902
Practice Address - Street 1:3601 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1229
Practice Address - Country:US
Practice Address - Phone:806-790-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY49206207T00000X
TXS9137207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40209512Medicaid
KY7100245890Medicaid
TX1K4394OtherMEDICARE