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NPI Code Detail

MEDICARE: JULIA ROSE LUTZ

MEDICARE: JULIA ROSE LUTZ
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
1363A00000XPhysician Assistant5601013179MI

General Provider Information

NPI Number : 1598646655
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA ROSE LUTZ
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 MICHIGAN ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-391-3139
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2025
Last Update Date : 12/08/2025

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Directions to “ JULIA ROSE LUTZ ” Practice Location

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