MEDICARE: DAVID J. 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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	01057270A	IN
2	208100000X	Physical Medicine & Rehabilitation Physician	01057270A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	250014246	OTHER	IN	RR MEDICARE
5	P00206255	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J. LUTZ M.D.

Provider Business Mailing Address
First Line	:	7956 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-436-2416
Fax Number	:	260-436-6936

Provider Business Practice Location Address
First Line	:	7956 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-436-2416
Fax Number	:	260-436-6936

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/29/2017

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Directions to “ DAVID J. LUTZ M.D.” Practice Location

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