Healthcare Provider Details

I. General information

NPI: 1952352221
Provider Name (Legal Business Name): LON LUTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 HUDSON BLVD N STE 135
OAKDALE MN
55128-7055
US

IV. Provider business mailing address

600 S CLIFF AVE STE 106
SIOUX FALLS SD
57104-5355
US

V. Phone/Fax

Practice location:
  • Phone: 651-313-8250
  • Fax: 651-313-8251
Mailing address:
  • Phone: 888-258-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number30820
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: