Healthcare Provider Details

I. General information

NPI: 1770549420
Provider Name (Legal Business Name): FRANK J LUTRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W PARK ST SUITE 303
URBANA IL
61801
US

IV. Provider business mailing address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 217-337-2924
  • Fax: 217-337-2703
Mailing address:
  • Phone: 630-324-7900
  • Fax: 630-324-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036095869
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: