Healthcare Provider Details

I. General information

NPI: 1265608186
Provider Name (Legal Business Name): BRANT JOSEPH LUTSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COTTONWOOD ST SUITE 203
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

5328 ROGERS ST
DAVIS CA
95618-7203
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-2600
  • Fax: 530-662-7330
Mailing address:
  • Phone: 312-339-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036113495
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number105415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: