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NPI Code Detail

MEDICARE: JOHN L LUTZ M.D.

MEDICARE: JOHN L LUTZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician02002752AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00436998OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27450536OTHERINAETNA
3000000505165OTHERINANTHEM
49472582OTHERINCIGNA
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7351972384-038OTHERINTRICARE

General Provider Information

NPI Number : 1356344337
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN L LUTZ M.D.
Provider Business Mailing Address
First Line : 1234 E. DUPONT RD.
Second Line : SUITE 3
City : FORT WAYNE
State : IN
Zip : 46825-1545
Country : US
Telephone Number : 260-373-9728
Fax Number : 260-458-5664
Provider Business Practice Location Address
First Line : 401 N. SAWYER RD.
Second Line : SUITE B
City : KENDALLVILLE
State : IN
Zip : 46755-2568
Country : US
Telephone Number : 260-347-8430
Fax Number : 260-347-8435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 09/29/2009

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