MEDICARE: JOHN CLEMENS PUTZ 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	207X00000X	Orthopaedic Surgery Physician	4301038199	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2003301032	OTHER	MI	BLUE SHIELD IDENTIFIER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861488082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CLEMENS PUTZ M.D.

Provider Business Mailing Address
First Line	:	1879 CIMARRON DR
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3811
Country	:	US
Telephone Number	:	517-349-9240
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 E MAIN ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-9741
Country	:	US
Telephone Number	:	989-584-6320
Fax Number	:	517-364-9130

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	12/09/2019

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