Healthcare Provider Details

I. General information

NPI: 1558581702
Provider Name (Legal Business Name): LUTZ E VENTZKE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date: 01/30/2008
Reactivation Date: 04/30/2008

III. Provider practice location address

7320 WOODLAKE AVE SUITE 210
WEST HILLS CA
91307-1483
US

IV. Provider business mailing address

22357 MULHOLLAND DRIVE
WOODLAND HILLS CA
91364-4934
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-3230
  • Fax: 818-883-4496
Mailing address:
  • Phone: 818-704-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA17887
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA17887
License Number StateCA

VIII. Authorized Official

Name: LUTZ EBERHARD VENTZKE
Title or Position: PRESIDENT LUTZ E VENTZKE MD A MEDIC
Credential: MD
Phone: 818-704-7248