Healthcare Provider Details

I. General information

NPI: 1750357927
Provider Name (Legal Business Name): CHRISTOPHER J LUTRZYKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1561
  • Fax: 207-626-1849
Mailing address:
  • Phone: 207-626-1561
  • Fax: 207-626-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number014426
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014426
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: