MEDICARE: ROBERT G LUTAN MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036085097	IL
2	207RC0000X	Cardiovascular Disease Physician	101315	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	060065494	OTHER		MORRMCR
3	060065495	OTHER	IL	ILRRMCR
4	177033	OTHER		HLNK
5	2500837	OTHER		UHC
6	4243966	OTHER		AETNA
7	5386951007	OTHER		CIGNA
8	12857V3831	OTHER		GHP/CMR
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	34842V8816	OTHER		HCUSA
11	F04428	OTHER		MERCY
12	149885	OTHER	MO	MOBS/BLCHOICE
13	98151V30946	OTHER		HLTHPART

NPI Number	:	1528051422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G LUTAN MD

Provider Business Mailing Address
First Line	:	11125 DUNN RD
Second Line	:	SUITE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

Provider Business Practice Location Address
First Line	:	11125 DUNN RD
Second Line	:	SUITE 204
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6132
Country	:	US
Telephone Number	:	314-839-5522
Fax Number	:	314-839-5351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	03/28/2022

11125 DUNN RD , STE 402
SAINT LOUIS, MO
63136-6132

Practice Phone: 314-741-3400
Practice Fax: 314-741-4357

11125 DUNN RD , STE 204
SAINT LOUIS, MO
63136-6132